What I’ve learned from saving physicians from suicide

A psychiatrist in Seattle had picked out the bridge. At 3 a.m. he would swerve across his lane and plunge into the water. Everyone would assume he fell asleep.

A surgeon in Oregon was lying on the floor of her office with a scalpel. Nobody would find her until it was too late.

An internal medicine resident in Atlanta heard an anesthesiologist joking about the lethal dose of sodium thiopental. Alone in the call room, she would overdose that night.

Three planned suicides. All three physicians survived. Why?

While preparing to overdose, the internist was interrupted by an endocrinologist calling to check on her. Before grabbing her scalpel, the surgeon called several physicians pleading for help — I responded immediately. Two days before he was to drive off the bridge, the psychiatrist spotted my ad for a physician retreat. He called me begging to attend.

One week later, I’m hiking through the Oregon Cascades. The scent of cedar envelops me as I approach the lodge where I’m welcoming physicians who have arrived from all over the United States and Canada, all of us on a pilgrimage for answers.

Tonight we begin a retreat for doctors who yearn to love medicine again. Studies confirm most doctors are overworked, exhausted, or depressed. The tragedy: Few seek help.

I ask the group, “How many physicians have lost a colleague to suicide?” All hands are raised. “How many have considered suicide?” Except for one woman, all hands remain up — including mine.

“Physicians have the highest suicide rate of any profession,” I explain. “In the United States we lose over 400 physicians per year to suicide. That’s the equivalent of an entire medical school. Even that’s an underestimate because many physician suicides are incorrectly identified as accidents.”

I tell them, “Both men I dated in med school are dead. Brilliant physicians. Loved by their families and patients. Both died young — by ‘accidental overdose.’ Really? How many physicians accidentally overdose?”

The room is quiet.

It’s easier to say accident than suicide. Doctors can say gonorrhea and carcinoma. Why not suicide? Maybe we can’t face our own wounds.

“I’m a family doc in Eugene, Oregon, where we’ve lost three physicians in eighteen months to suicide. I was suicidal once. Assembly-line medicine was killing me. Too many patients and not enough time sets us up for failure. Rather than kill myself, I invited my patients to help me design an ‘ideal clinic.’ It is possible to love medicine again.”

The Canadian doctor to my right wipes her eyes. “I’m feeling so discouraged. I want to give up and work at Starbucks. My head is exploding from banging it against the system.”

A bright-eyed, blonde woman reveals, “I just took a leave of absence from med school because it was ‘killing my soul.’ Three classmates attempted suicide.”

A newlywed couple join in. “I’m a nurse. My husband is an internist. He’s suffering, but I don’t know how to help him. Doctors don’t seek psychiatric care because mental illness is reportable to the medical board. He fears he’ll lose his license.” Her husband adds, “I was suicidal three months ago. On the edge. My wife and I are hoping to find answers here.”

Here, physicians, nurses, and medical students share their wounds and their wisdom — in community. We share new practice models, communication techniques, and strategies to care for ourselves — so we can care for our patients.

In four days, I witness more healing than in four years of med school. Once strangers, we’ve become family. Parting ways, the psychiatrist from Seattle thanks me again.

I didn’t know these doctors, but I know their despair. By speaking about my own pain, I validated their pain. By being vulnerable, I gave them the strength to be vulnerable too.

But mostly we healed each other by not being afraid to say the word suicide out loud.

What I’ve learned from saving physicians from suicide 493 comments

Wow. Very moving. Question though. What is the percentage rate for suicide among nurses? After your answer, I may be contacting you again with more questions and in need of information.

PamelaWibleMD

I am not certain the suicide rate among nurses. I am sure there is much burnout and depression, though I am unaware of those numbers. Suicide data is hard to come by because of our denial which fuels the problem. The best numbers I have are in the article above. I certainly have lost a lot of colleagues over the years. Never lost anyone outside of medicine. Only physicians. And the colleagues I have lost are all male physicians. Please feel free to be in touch with me, Kristy. Happy to help nurses. I host a biannual retreat for all health care providers suffering from burnout, depression, suicidal thoughts.

Kassy Daggett

I love that you’re considering this as a project for Nursing School.

Guest

“Physicians have the highest suicide rate of any profession”

Bold claim, frail data.

Lots of professions claim they have the highest suicide rate of any profession. Local studies indicate elevated rates in different occupations, but the data usually turn out to be frail.

Only about half of all states even put “occupation” on their death certificates at all, thus there is no national data set on occupation and suicide.

PamelaWibleMD

I agree. Unfortunately our denial of the problem can lead to poor data. I have asked the state medical board to track physician suicides. They have little interest in doing so. They DO track physicians with drug problems, sexual indiscretions, and out them to the rest of us in quarterly newsletters that come right to my mailbox. Why not track physician mortality or suicides? This can be done without naming the physicians.

Why are we not tracking physician suicide data? Physician suicide is the triple taboo.

Taboo #1 – DEATH
We live in a culture that fears death.

Taboo # 2 – SUICIDE
Suicide is death in your face.

Taboo #3 – PHYSICIAN SUICIDE
Those who are supposed to help us are harming themselves.

It’s apparently too much for some people to handle. Ignoring it does not make it go away.

Matt

“Why are we not tracking physician suicide data?”

From the link above, half of all states are not tracking ANY suicide data by profession. It’s not actually all about you.

Mengles

Based on your comments, you certainly have an axe to grind against doctors don’t you. So sad, but not surprising.

PamelaWibleMD

Ummm .. .?

Marianne Trevorrow, ND

I agree that this is a taboo subject. I lost a family member, an internist and cancer researcher, to suicide over 40 years ago and it was never discussed, leaving me with many questions about that member, the profession in general, and what it says about all of us. I applaud Dr. Wible for bringing it to light. And yes, I also agree with the previous post that we need to study this–why should suicide be an occupational hazard in a healing profession?

PamelaWibleMD

Yes! Marianne! Of course suicide should not be an occupational hazard for a healer. . . .

Why is it?

Matt

“Of course suicide should not be an occupational hazard for a healer. . . .”

You’re insinuating that it SHOULD be “an occupational hazard” in other professions?

PamelaWibleMD

Nope.

Sheri

Marianne, reading through all of these very interesting posts, I am left wondering the same myself.

Marianne Trevorrow, ND

I think any health care provider can be prone to feeling fatigued and burned out if he or she doesn’t attend to their own needs. Feeling suicidal, however, is well beyond standard ‘burn out’, however, and I suspect to do with a ‘perfect storm’ of financial, emotional, and malpractice pressures for many doctors. Plus the taboo of not feeling like there’s anyone you can confide in.

Sheri

Thank you, Marianne, for your insightful reply. I am now wondering if feeling suicidal goes deeper even than the perfect storm you write about. When you have two people with similar issues, I wonder what would trigger one to commit suicide and another not? I don’t know the psychology of suicide but this article has really got me wondering how a person comes to a decision that that is the only solution to their problem?

Kassy Daggett

Hey Marianne, Well stated! Getting relevant support is so crucial.

guest

Dr. Wible,

Could you please expound on your patient-designed clinic? You stated that such changes enabled you to work in a healthier environment. What changes occurred/how was the clinic designed, and do you believe that this would be a feasible model over a wide range of specialties

PamelaWibleMD

I am happy to send you a 10-page FAQ that will answer your question in detail. What I did find most helpful is the following:

1) Being vulnerable and sharing my pain and grief with others in the community. Then asking for their help.

2) Hosting town hall meetings and inviting the community to design their own “ideal” clinic. I collected 100 pages of testimony, adopted 90% of feedback, and opened the clinic one month later.

3) Working for my patients (not administrators). This is the first time in my career that my job description has been written by my patients. And turns out my patients and I want the same thing.

As a result, I now work a humane schedule. Patients have more respect and love for me than they did in an “assembly-line clinic.” Though I still take insurance, my uninsured patients are happy to pay at the time of service. It’s easy, painless, and lucrative to be self-employed in a community-designed clinic.

My overhead is extremely low due to (learn this word): DISINTERMEDIATION = removing the middle man. And yes, this can be accomplished in any specialty.

Sheri

Dr. Wible, have you ever been invited into a medical practice to help turn the model from status quo into an “ideal clinic.” Like actually being physically present for coaching the transition?

PamelaWibleMD

I have been on site for hospitals transitioning into community-designed ideal hospital. I train docs at biannual retreats. Give them the community organizing and business skills they need to open community-designed “ideal” clinics. Hey, this could be a great reality show!

Sheri

Well, with medical drama so popular on television, I would have to agree with you. I would watch.

Sheri

You know, this would make a great documentary and teaching tool (hopefully for medical schools, too) You going into a suffering practice and helping the doctors and staff turn their unhappy practice into an Ideal Medical Clinic. Have a crew follow you filming the healing transformation. Then film the follow up. This is something that as a non medical person, I would be very interested in watching.

Bruce

This is, I think, a great idea!

Could even eclipse “Restaurant Impossible”!

Maybe OPB should get into this community-serving kind of reality TV.

Maybe via Independent Lens?

Sheri

Bruce, Independent Lens is a great idea. OPB, another. How could one make this happen?

Bruce

Sheri, I’m not sure, but I’m going to make some exploratory inquiries tomorrow. Thank you for “catalyzing” me to do so!

Sheri

Thanks, Bruce. I can only imagine the changes that would occur, the people that could be helped and saved, if this was brought out into the light of day where more people could have access to this taboo subject. Please post if you find anything out.

Bruce

Sheri,

Ditto! Will do!

Bruce

Sheri,

Contacted Independent Lens and FRONTLINE today!

Now, let’s see what transpires in response!

Sheri

Bruce!!!!!!!!!! You are amazing!!! One can move mountains, thank you. Please keep us posted here.

Bruce

Sheri,

Thank you! Yesterday, contacted the “Fresh Air with Terry Gross” radio show, and [Bill] MOYERS & COMPANY, about Dr. Wible’s pioneering work in Community Designed Ideal Health Care”.

Sheri

Wow Bruce!! This is great news. I applaud your work for the cause. I am impressed. Thank you.

PamelaWibleMD

Thank you Bruce & Sheri for keeping the conversation growing!

PamelaWibleMD

YES! Real TV. Let’s solve our greatest social problems on TV.

buzzkillerjsmith

Healing in 4 days. I am dubious. It will not last and the wounds be split open again unless these folks get out of their current jobs. Many medical jobs (not mine fortunately) are a living hell and must be escaped.
Docs have to give up the fantasy that they will save the world. The world does not want to be saved. If it did, its degeneracy would have been lessened by now.

Docs have to give up the lust for money. The combination of a good living and a good job is gone, at least in primary care. I doubt it’s coming back soon. You have to get off the firing line to save yourself. Your corporate masters will not save you.

Smart young folks have to be discouraged from going into medicine. Those smart young folks that we care about, that is. Not so sad, this has all happened before in other trades. The blacksmiths are gone.

PamelaWibleMD

I can appreciate much of what you are feeling. When young doctors-in-training visit my office they tell me I’m the first happy doctor they have ever met. Some say that I’m the first solo doctor they’ve ever met. We need more happy docs training the next generation of healers. Unfortunately discouraged doctors teach medical students to be discouraged too. And cynicism kills creativity.

buzzkillerjsmith

I’m not really feeling as much as you think I might be feeling on this particular issue. I’m analyzing the situation dispassionately.

In truth this country does not give a rat’s hinder about primary care. Who are we to disagree?

I for one have moved on. And I do precept Univ of WA med students and share none of this analysis with them. There’s nothing more irritating than an old doc on a soapbox. That said, I was talking about discouraging smart college students. The med students cast the die.

As regards creativity: Always remember that something not worth doing is not worth doing well. But I admire your continued engagement even if I don’t sympathize with it.

Guest

Oh, buzzkillerjsmith – are you are giving up on primary care? Really? And still precepting?

PamelaWibleMD

Don’t give up. We need you. 🙂

PamelaWibleMD

Oh, buzzkillerjsmith, are you giving up on primary care? Really? And you are still precepting? That must feel weird.

buzzkillerjsmith

Give it up? Heck no, I like primary care, and I like precepting. I’ve given up on trying to change the system, that’s all.

Kassy Daggett

Dear Buzzkiller, Sounds like you’ve earned your name here! Come to the workshop and see for yourself. All cynics are most welcome!

May Wright

If suicides are more prevalent among physicians than among soldiers, why don’t we see the NYT and other liberal media touting the “damaged physicians” narrative as often as they do the “damaged vets” one?

azmd

I don’t recall seeing the piece saying anything about relative rates of suicide between physicians and soldiers. Clearly there is an alarming trend towards increasing suicide rates in the military. As to why that trend is being covered so meticulously by the NYT, but one does not see coverage about physician suicides, I would guess that it’s a combination of reasons, one of which is that physician suicide rates are an old story and the other of which is that the NYT has a pretty obvious anti-physician editorial bias.

PamelaWibleMD

This piece was almost picked up by the Wall Street Journal as an op-ed. I got a very nice personal letter from them. NYT declined this op-ed. I think physician suicide is much more taboo than veteran/military suicides. Our military go into war zones; killing is part of the job description. Physicians, on the other hand, are supposed to safeguard life. And now our healers are harming themselves. TMI.

The author of this article made the claim that “Physicians have the highest suicide rate of any profession”.

So those who delight in saying there must be something poisonous about the military, that so many of their people end up offing themselves, should say the same about the medical profession. Those who complain that the military must do a lousy job of screening out nutcases, must make the same complaint about the AMA.

PamelaWibleMD

Common feeling among the masses is that doctors are closer to the 1% than the 99%. Damaged vets are in with the 99%. Easier to feel sympathy for the underdog.

Dave

I think it has less to do with their ideology than the sad fact that doctor suicide is not a new post-9/11 phenomenon while the rise of veteran suicides is, especially those from OEF/OIF. Vet suicide and PTSD also fits into the larger narrative about the war and the aftermath, a topic covered extensively in the media. The worries and woes of physicians have received sporadic mention for the past 10 years, while I would wager that no newspaper of note has published an issue in the last 10 years without at least one article or op-ed on a war. If more is written about the plight of physicians in general (not just ‘medicine’), then stories about their rising suicides would probably get more exposure.

PamelaWibleMD

I submitted the piece above to over 15 newspapers in America. None were interested. It is disheartening.

Guest

Nobody is especially sympathetic to the woes of the One Percent these days.

PamelaWibleMD

But we are not the 1%. Are we?

Bruce

You are right, doctors are most decidedly not the ruling minority; they are, even those with the highest monetary compensation, at most “highly paid employees” — or “House Niggers” — of the real rulers: the Rockefeller “Eugenics” Family, the controlling owners of J. P. Morgan Chase, of Goldman Sachs, of Citibank, of Bank of America, etc.

The funny thing is I am a recent grad and associate with other recent grads. No one is rich nor has aspirations of being rich. I wonder what we are missing…

PamelaWibleMD

Divide-and-conquer society. Pitting people against each other keeps us all running around in circles. Power structure stays intact.

Bruce

You said it. Divide-and-conquer — tricking desperate people whom they have impoverished to attack — and to kill — other desperate people whom they have also impoverished, is their primary tool of rule.

And “we, the people” have kept falling for this trick, the main weapon in the arsenal of the ruling sociopaths, eon after eon after eon.

High time for a change — long since!

Before it is too late!!!

PamelaWibleMD

“But I say unto you, love your enemies, bless than that curse you, do good to them that hate you, and pray for them that despitefully use you.” ~ MLK

Bruce

I agree to this extent —

“Nonviolence is a key to the effectiveness of efforts for social betterment, because violence corrupts its initiators, converting them, even if their violence is “successful” in overthrowing the violent tyranny that they had opposed, into but the new
incumbents of the very evil that they had intended to overthrow — reinstating
that evil through them, as them — and thus resulting, for them, and for humanity as a whole, in a defeat which could not be more complete.”

Sheri

This “1%” that you speak of, are the very souls who will be asked to repair and heal your body and the bodies of your loved ones someday. Perhaps even in a life or death situation. The problem goes so much deeper than how much someone earns a year, how much more they are earning than we are. The problem lies in the institutions that dehumanize the medical students that will someday be our health care professionals. The problem lies in the inhumane training medical students have to go through in order to come out and help people. It appears from Dr. Wible’s article that those very medical students are injured in the process, come out broken and broke. I do believe that is the issue here, how to heal the system to make for better and more whole healers. How to change the medical culture so that it is healthy, not sick and broken.

Sheri

Makes me wonder if the AMA sits on the boards of media outlets? Very disheartening, I would love to know why they weren’t interested.

PamelaWibleMD

Taboo topic.

PamelaWibleMD

Local newspaper reporter told me that they will not print “suicide” unless family wants it in the obituary.

Sheri

Which topic is taboo? AMA’s influence or Newsmedia disinterest?

PamelaWibleMD

Suicide. And especially physician suicide.

Sheri

It is so ironic to me, a profession which deals closer with life and death than any other, that death by any means would be a taboo?????

Bruce

All too typical! The main media do not serve the public — they are owned by — or cowed by — and they serve those who we let enslave us.

PamelaWibleMD

Ah . . . and when the people lead, the leaders will follow.

Bruce

I think that you just stated the prescription for the cure to our COLLECTIVE malady!

Guest

Doctors are obviously even more mentally unstable than soldiers. That’s a worry.

Matt

They use the “damaged vets” narrative to denigrate the military in general, and those who serve. They’re not interested in similarly trashing civilian medicos.

Mengles

Have you even see how much the NYT goes after doctors?

Kassy Daggett

It’s all about what sells papers and air time. When this topic starts doing that they’ll be all over it. Have any ideas about how to get “that” ball rolling?

Anthony D

The problem is that many in the media and in society don’t feel sympathetic for doctors because they get demonized continuously by wrongly accusing them as rich, greedy individuals that only care about their bank accounts, rather then the care for their patients.

So many will play the smallest violin for these healthcare workers.

Guest

And remember, Obama said doctors go around unnecessarily cutting off feet and ripping out tonsils just for the $$, when they COULD have just cured your diabetes or treated your allergies, but those things don’t pay as well.

That wasn’t exactly helpful.

PamelaWibleMD

When did he say that?

Dave

FYI we have a few tinfoil-hat-wearing regulars here.

Mengles

You might want to actually check where he did say that on that little thing called Youtube.

Molly_Rn

President Obama never said that.

Matt

Oh yes he did. One of the KevinMD bloggers even featured a video of it a while back.

Molly_Rn

It was taken our of context and the right wing went bananas with it as usual.

PamelaWibleMD

So true! It is very hard for patients who are angry at their doctors to muster up any compassion for them as human beings.

Kassy Daggett

So many problems and so many small violins. How can each of us take the next step in activating real change? It’s NOT about doing 1 thing 100% different, it’s about doing 100 things 1% different.

PamelaWibleMD

How do you think we could start getting accurate data?
Curious your thoughts. . .

buzzkillerjsmith

Whew, at least I didn’t follow my dream of becoming a marine engineer!

PamelaWibleMD

Yep! I know.

May Wright

At the bottom of that article was a link to
The 15 Jobs Where You’re Least Likely To Get Divorced:
“Agricultural engineers — 1.78% divorce rate”. As a farmer’s wife (he has an agricultural engineering degree from Texas A & M), I am happy to hear this 🙂

Sheer numbers. About 1 doctor a day commits suicide. About 22 vets a day commit suicide. Granted, there are many more vets than doctors. I have a lot of respect for doctors. They have a long and very challenging training period and a very challenging career. Most seem to be very decent, competent people.

PamelaWibleMD

And for every fallen physician at least 1000 patients (including vets) are left with no doctor. This IS a public health issue. Who cares for all the wounded in America?

Rose

Dr. Wible, thank you for having the courage to speak out on this topic. While I am not a physician, I have worked in healthcare for over 25 years. Several years ago, I was in a clinic where one of the physicians ended his life and it had a profound effect on me. It was his first position (post internship/residency).

This kind soul wanted to read every progress note before seeing a patient – he was meticulous and thorough; but, only seeing 5 or 6 patients per day will not pay the bills in today’s primary care setting. I wish I would have read this article back then and known that so many physicians contemplate suicide. While I could see him struggling to come up to speed, the final outcome of him taking his own life was not something I even considered.

If those of us that work in healthcare can become more aware and be able to offer the right kind of help – a retreat, EAP, a different position – perhaps we can help save a life. I know of one that ended far too early.

PamelaWibleMD

The numbers are shocking. I have to say that even I was astounded when I asked the group how many have lost a colleague and all hands were raised. What other profession would have so many hands in the air?

karen3

Law

Guest

and dentistry

Matt

And the military. Everyone asks the question, “What’s wrong with the military,that they attract such mentally unstable people???” I guess it’s time to turn and ask “What’s wrong with med schools that THEY attract such mentally unstable people?”

PamelaWibleMD

Healers are often wounded themselves. That is often what attracts them to the profession in the first place.

Dustin Salzedo

Veterinarians – nothing like starting your average day euthanizing young, healthy animals as a result of human greed (breeding for $$), cruelty and indifference (doesn’t go with the new furniture)

Nurses – licensed professionals largely working as employees where responsibility < authority to act congruently with professional ethics and patient well-being.

PamelaWibleMD

That is SO depressing. The euthanizing of healthy animals is why I never became a vet. Unfortunately, in medical school we were forced to kill dogs and torment sheep as part of our “training.” Absolutely barbaric and soul-murdering experience. I almost quite medical school in protest and they finally let me opt-out.

Kassy Daggett

I’m so sorry for your loss Rose. I like your ideas about how to implement “real” change. How might we transform the memory of our dead doctor friends into a commemorative legacy?

PamelaWibleMD

And this RAC fiasco is enough to throw any doc into a major depression (or worse):

I think the Physician suicide rate has a few common factors based on my experience as a self employed FNP. I can understand the pressure: poor reimbursement in family practice, RAC audits taking back previous remibursements ( I UNDERbilled and still was liable for paying back the funds for my house calls), not enough time to address patient concerns, mounting bad debt from uninsured patients, pressures to make payroll, paying all the expenses of practice–especially regulatory overhead—my EMR debacle was very costly, in my case, MDs implying to patients that NPs do not give good care (yes, my patients told me about their conversations with the urgent care MDs). And a host of other things, like working the first 4 years alone. I had employees the last two and a half years. I quit last December. I had enough. Now I’m overqualified for being an employee, so I remain at home. Where is an NP with a PhD and two master’s supposed to fit in? I am considering church missions at this point because I love to use my skills.

PamelaWibleMD

We really do need to work together and create a nurturing environment among all health care professionals. And being fined for UNDERbilling is just sickening.

Dustin Salzedo

Except for your supportive comment, all of the other responses to this nurse’s aborted career and distress are demeaning, insulting and reflect EXACTLY the status quo.

I am a former nursing administrator, blacklisted for whistleblowing (AKA just doing my job and acting to ensure legality and ethics) and have had my life destroyed. Until you’ve walked in our shoes or you have empathy for these experiences, kindly go back to your ostracism in silence.

PamelaWibleMD

Let’s all develop more empathy and compassion for one another in the medical field. It would go a long way. We need to heal health care (and help one another) if we are to be able to heal our patients. Let’s lead by example. I love medicine.
We can save our beloved profession if we first start with ourselves.

Sheri

Agree!!!! A journey of a thousand miles begins with a single step. Lao-tzu, The journey of healing the profession begins with healing individual doctors. Thank you Pamela, for walking your talk.

Sheri

Is the vehemence towards fellow practitioners learned in medical school? I agree with your response regarding the negative comments. Does this air of disrespect permeate the field?

Guest

“Now I’m overqualified for being an employee, so I remain at home.”
—————————————

Seriously?? You may feel “overqualified” for being a mere employee, but you’re obviously not suited to being a businessperson. You can’t do B because you’re not suited to it, and you don’t feel like doing A because you’re just too SUPER, so you just give up?

Imagine if you were in the real world, where people HAVE to work in order to feed, clothe and house themselves and their family whether they want to or not, whether they feel it’s “beneath them” or not. My father was a surgeon in Iran, he was finally able to come here when he was 53, he spent the next 12 years driving taxis. Providing for yourself and your family, however you need to do it, is never beneath you. Have some pride.

Guest

Well, clearly he can afford to stay home so who cares about the reasons? I envy him!

Mengles

“Where is an NP with a PhD and two master’s supposed to fit in”
You may want to ask your nursing faculty this question.

Sheri

Read Pamela Wible’s book Pet Goats and Pap Smears. It is the how to manual to make it work and get your life and profession back from the system that holds it hostage.

PamelaWibleMD

Will do!

TB

I am very interested in creating more dialogue among medical students on this topic. During my training my school only gave a quick overview of how to maintain good mental health, which I feel was quickly forgotten by most students who wanted to protect their air of invincibility. Have you explored creating similar programs in collaborative with medical school administrations? Or do most schools find the topic too taboo? Thanks for the article.

PamelaWibleMD

Great idea, TB. Will work on this next . . .

AJ MD

As I understand the physician suicide numbers, they have one of the highest rates of successful suicide attempts due to knowledge and access to potentially lethal medications. Physicians can be susceptible to mental illness, including depression, just like anyone else, and they have a large stigma limiting treatment of mental illness as all treatment is reportable to medical boards, insurance networks, and hospital staffing. So there is a fear of being “exposed” as needing help for depression and affecting ability to be allowed to work as a physician, even if medically stable. Dr. Wible has pulled back the curtain hiding this problem for all to see, including other physicians. She is one of the best resources available to help medical providers with these issues. And an emotionally healthy doctor will be much better with their patients.

Guest

100% correct. I work in a large private practice and in the past 5 years we have had 3 physician suicides. They all took drugs from the hospital to do the deed. They were all middle aged males who likely felt too ashamed to admit “I need help.” It’s haunting. I keep an eye on my colleagues to check for signs of trouble, but as a young female physician I wonder if they’d feel comfortable confiding in me.

PamelaWibleMD

Wow. And drugs from the hospital. Did they openly discuss these as suicides or were they “accidental overdoses.”

Guest

All 3 individuals used paralytic agents as part of the suicide drug regimen. Hard to claim it was recreational use gone awry. It’s still so hard to believe that they got to that point, as I knew they had their problems (who doesn’t?) but had no idea how much pain they were in.

PamelaWibleMD

How many docs in your large private practice?
What intervention did they offer the surviving physicians in the group?

Sheri

Very haunting, indeed. Very.

Sheri

I totally agree!!!

Guest

Dr. Wible is bringing to the surface a very difficult issue for our culture to deal with (or be willing to deal with). Whether or not physicians have the highest suicide rate as a profession is immaterial. The important point is that the profession made up of those who have committed their lives to helping others have a high rate of suicide because the system is sick. When the “system” is sick it makes those who want to heal the sick, sick themselves. It not only is a personal tragedy for those physicians who are struggling, but for their patients as well.

Dr. Wible probably feels like a voice in the wilderness at times, especially when trying to get the media to listen and then tell our society about the issue. If all those who share this concern come together with a single voice, a voice of hundreds, then perhaps they’ll listen. In the meantime, my heart goes out to all those who wonder at the end of each day whether or not it’s worth it.

Bless you, Pamela, for all you’re doing.

PamelaWibleMD

Time to end the silence, the denial.

Sheri

So very well said. Yes, thank you and bless you Pamela.

Judith Wible

As a retired psychiatrist i think this is an issue that has been ignored or hidden for so long that the real number of physician deaths by suicide is far higher than any of us would like to admit. In medical school we were not given any training in dealing with patient death and physician suicide was never uttered aloud.

In this day of accelerating change in healthcare it is time to rise above the programming of our medical education – where we learn to NEVER admit we are struggling or (heaven forbid) ask for help – and look out for our physician colleagues. If you see someone struggling … ask if they are OK … offer your support AND expect them to deny there is a problem and turn you down … so offer again and again when you see a burned out or depressed colleague. Make sure they know you are there when they are ready for a shoulder to lean on.

We are conditioned for a minimum of 7 years in med school and residency to be superhero, lone ranger, perfectionists. This brainwashing blocks our self awareness and prevents us from asking for help … especially men.

The beginning of all change is calling things by their true name. If you or a colleague are having difficulty … call it, talk about it, reach out, get and offer support. Suicides don’t just happen … they are the end of a long downward spiral … checking in with a colleague can save a life.

Dike – appreciate your work in this are too! It really takes all of us to start looking out for one another and noticing the signs of burnout and depression. Didn’t you have a list of what to look for in colleagues?

I don’t have a list Pam … and I will give you a tip, specifically for physician leaders. The last people who notice a physician is in trouble is their partners. All the doctors spend their days in their own offices on their own individual gerbil wheels. Listen to your staff. The nurses and others who room the patients are the ones who spend the most time with the doctors. THEY are your early warning system.

Disruptive behavior, relentless sarcasm and cynicism, obvious physical exhaustion, complaints from staff – especially if no one wants to work for/with this doctor … are all reasons to reach out. AND prepare for the physician to deny there is an issue – their admission of difficulty can only come when they are capable of overcoming their programming to “Never show weakness”.

Be caring and persistent and sincere in your support. I have plenty of other resources if anyone has a specific challenge or question.

Dr. Pamela Wible has found a way out of the healthcare wilderness in a way that meets her needs, apparently providing for herself financially, securing the personal space and autonomy that are important to her happiness, and filling a spiritual need by helping those in distress, not merely patients, but perhaps ironically to some, to the providers of healthcare as well. She has stepped off the factory conveyor belt and within her expanding sphere of influence has put both health and caring back into healthcare. In doing so she models the way for the rest of us to find our way out of the box.

None of us are as trapped as we may at times think we are. Many times our chains are paper chains, because we think there are no viable options. That phenomenon usually characterizes the thinking of the suicidal, inside or outside the medical profession. It is a form of desperation, the ultimate entrapment. Suicide is often the final act of a terrible lack of imagination.

Thinking in terms of the group is a trap that creates desperation. It leads us to believe that any and all solutions can only be group solutions; that unless the oxymoron known as American healthcare is totally revamped, we have no options. That solution is overwhelming to even contemplate; it took over a hundred years to get this bad, and assuming the burden of fixing it is enough to depress anyone and send them over the edge.

But Dr. Wible models a different way of thinking. We don’t have to fix the world or even American healthcare. We only have to find ways to put the autonomy, freedom of choice, and things that make us personally happy and integrate them into a highly customized lifestyle for ourselves. Anything is possible to us, if we can think outside the box long enough, and if we are willing to make some necessary trade-offs. In the long run, we will all do more to change the direction of healthcare in this country than all the politicians lumped together, but we will do it one doctor and one patient at a time.

Bravo, Dr. Wible! Keep the conversation going!

PamelaWibleMD

The health care reform we seek is ultimately from the inside out and the bottom up. Health care can never be mandated from the top down.

Bruce

Here! Here! You said it, so well!

Molly_Rn

Claire, you have taken this completely out of context. Was it the organizations or individual Republican members. This is the wornout BS from the right filled with hate and it is not befitting this discussion.

Guest

You should click the links she provided. They were official statements, one from the official FACS site.

Molly_Rn

Thanks

Mengles

The links are from ACTUAL doctor specialty societies not politicians.

Molly_Rn

Still taken out of context. It’s like the Bible; you can find support for anything in it if you take it our of context.

Molly_Rn

I am a nurse and a physician’s wife. This is not a new problem. We have lost many friends to suicide that were excellent caring physicians. This is much more than perceived threats by new laws providing more Americans healthcare or the ridiculous time constraints on patient visits. I would suggest you look more closely at the issues of the profession where you are expected to save everyone, perform miracles when there is no hope, where every baby must be born perfect, always know the wise thing to say and never ever grieve. You are human beings that on the one hand people want to be god, but if you act like you are a god they hate you. You should never leave a patient waiting in your waiting room but have all the time in the world when a troubled patient needs your time and caring. You are the profession where the buck stops and your patients and their families do not understand enough to know when your back is against the wall and you are doing the best you can. And then there are the lawsuits with attorneys who make their living by suing physicians who would characterize all physicians as greedy bastards, when they are actually talking about themselves. If I had an
answer, I wouldn’t have lost so many wonderful friends. I suspect the answer must come from within the profession, by physicians learning to care for themselves better. I also suspect that you must come to the place where death is not the enemy and where you cannot protect the ones you love or yourself from death. I don’t envy you. I do however appreciate that you continue to give so much of yourselves for your patients. Too many good people are dying.

PamelaWibleMD

Excellent point:

“I suspect the answer must come from within the profession, by physician learning to care for themselves better.”

And then we may start to care for each other . . .

Molly_Rn

Step one admitting to yourself that you are human and despite all of your knowledge and hard work you remain human. That’s OK. Now you can learn to care for yourself.

PamelaWibleMD

Medical education is dehumanizing and that’s where much of the problem starts.

Molly_Rn

I would agree plus you have to promise yourself if you just hold on until you graduate and then hold on a little longer until you finish residency and then you will have a life. False. You are now up to your eye balls in debt and trying to start a practice or join a practice or at least make a living. If you are lucky you find some one who really loves you or is stupid enough to marry you. And then there is malpractice. I wonder how many doctors ask themselves if it is worth it. All that wonderful idealism pounded into the ground.

PamelaWibleMD

You are 100% correct. Such a tragedy for young people who just want to be healers.

Molly_Rn

My husband wanted to be a doctor to help people; he didn’t even think about how much money he would make. I felt the same way about being a nurse; we just wanted to give back to the community.

PamelaWibleMD

The ultimate abuse. Taking advantage of humanitarians.

PamelaWibleMD

Molly-Rn – what do you suggest we do about this?

Molly_Rn

As a good Swedish American, I like the Scandinavian model where we pay taxes and get something for it like an
education. We need an educated population with physicians, engineers, teachers and social workers, but we put them terribly in debt. Maybe we could have a program where the federal government pays for medical school and residency in return for X number of years working in a poor section of Appalachia or, Texas
or Detroit. We have areas of the country starving for physicians. Not being in debt and being the really good guy in a community that really needs you would help the old altruism and the pocket book. Their time working in communities of need are not freebies, they would have proper reimbursement.

PamelaWibleMD

We do have a federal program that does loan repayment in the USA. I do think making medical school free or much more affordable would help the economic stranglehold, but the dehumanizing effects of reductionist medical education may be part of the problem. We are taught to dissociate from ourselves. And then patients wonder why they can’t connect with us. Maybe because nobody is home.

Molly_Rn

I agree the compartmentalization is useful when you are caring for a trauma victim and if you are throwing up on them it would not be helpful. But we all need to learn how to turn it off. Perhaps there should be a way to grieve or deal with your frustrations
and grieve with other physicians and allow yourselves these emotions without burning out or wallowing in grief without resolution. It is not easy to let yourself care….just enough to be human and to respond as a human, without becoming unprofessional or caring so much that you burn out by destroying yourself. I still have
nightmares about some patients, BUT when you cease to care about your patients as fellow human beings you really cannot help them except technically.

PamelaWibleMD

True. We need mandatory physician debriefing sessions or balint groups weekly. Same for medical students. We can not take all this trauma in isolation and be well as the end of the day.

Molly_Rn

When my husband was medical director of a large ED, he would have debriefing sessions after a really bad trauma situation or if a victim was someone who worked at the hospital known to all, so that they didn’t have to bear their grief alone. It isn’t weakness to cry.

PamelaWibleMD

A premedical student recently told me how unprofessional he felt it was that a doctor broke down and cried after losing a young patient in the ER. I asked him to think about whether anyone was hurt by her tears. And then to consider why he was so uncomfortable. What’s wrong with crying in front of patients? I do it. It can be comforting to share grief communally-even with patients.

Molly_Rn

In ICU, many a patient whose hand I have held and cried with them while they are dying. For heaven’s sake we are human beings. Patients and their families hope desperately that you care about their loved one and that it isn’t just a job to you.

PamelaWibleMD

Women physicians have told me they feel guilty for crying. They do not want the male physicians to look down on them as “weaker.” Why are men so afraid of emotions?

Molly_Rn

Because they have them shamed out of them. I have two sons and I told them real men are so strong they can cry and they can be gentle and caring. Only weak men cannot cry or be kind, because they are not sure of their manliness. It worked! I do honestly believe what I told them. It takes great strength and belief in yourself to allow your emotions to show and to show kindness and concern.

PamelaWibleMD

YES! Now let’s help our male physicians feel it is okay to cry. That may be very therapeutic!

Molly_Rn

Agreed.

Sheri

Thank you Molly, for teaching your sons this beautiful truth.

Bruce

Unfortunately, today, this cowardice of men, disguised as “manliness”, is epidemic. And, partly as a consequence, not only physicians, but soldiers too are committing suicide — in droves!

Molly_Rn

Just spent the weekend with our two adorable identical twin 7 year old grandsons. They cry when they are hurt whether or not if is physical pain or emotional pain. Men are just little boys grown up and pain of any kind is still real. Real men cry and allow themselves to grieve. We must help our physicians and our soldiers to grieve and to know that we think more of them not less.

PamelaWibleMD

Amen!

Molly_Rn

Perhaps medical education and residency would be more humane to the students if they weren’t all type A math/science whizzes and had a few who took some humanities. I learned more about what it takes to live a good life from reading Solzhenitsyn than from any medical or nursing book. We are all more than the sum of our parts; we have hopes and dreams. Patients were once healthy people with ideas,
families, things they loved to do…. and since our goal is to return them back
to health that entails more than just getting their heart/lungs/kidneys
functioning again. We must see them as whole people and also just as
importantly see ourselves as whole people too.

PamelaWibleMD

A wonderful warm-hearted and intelligent premedical student recently told me that her premedical advisor suggested she pursue social work rather than medicine. Her grades and extracurricular activities were not as competitive as other cut-throat premeds so she was dissuaded from a career in medicine. Later I discovered that premed advisors often discourages students from a career in medicine so they can keep their % acceptance rate high in their college marketing materials. Sad.

Molly_Rn

God only knows we don’t want a caring and concerned doctor! My motto in chosing a physician is, “would I want he or she to be the one to tell me that I have pancreatic cancer?” If the answer is no than I need to keep looking. Recently had pneumonia (lobar) and was hospitalized for a week; I was so happy that Peter, my doctor, was there for me when I couldn’t protect myself. He is extremely bright and just as important kind. I could easily trust my life to him. Remember that is what people do. They literally trust their life to you.

Sheri

So sad.

Bruce

You are so right, and this “reductionism”, the lack of the “holistic” perspective that you outline, is the biggest, deadliest, and most dysfunctional deficit in our present culture — a kind of “enthnopathology” for which no healing specialty presently exists!

Molly_Rn

Again the art and science of medicine must both be there. Physicians must be allowed to be human first. If you don’t take care of yourself, how can you help others?

PamelaWibleMD

Exactly! A no-brainer really.

Sheri

Why is it so wrong for doctors to be actual human beings? Why does medical school want the graduates to be dehumanized?

PamelaWibleMD

Sheri –

1) They think professional distance will protect us.
It often does the opposite.

I think there is tremendous merit in that suggestion. Mental and emotional care for medical professionals needs to be regularized and institutionally integrated as a matter of course!

Bruce

I agree: the Swedish and the general Scandinavian models have a lot to offer we Americans in discovering how to heal our society in general — that’s exactly why we hear so little about those models in the plutocracy-controlled media.

Instead, we are told by those media that we should be ashamed of any benefits we ever receive from our government.

Ironically, the government is increasingly organized to extract only from the majority, and to lavish the proceeds — super-welfare for the super-rich — only upon a tiny minority — 1% of 1% — that has used their concentrated money to prostitute our entire government.

The plutocracy’s increasing subversion of democracy and of the well-being of the majority — in America, and worldwide — is the larger backdrop of the issues of the degeneration of public health — including of physician health — so ably discussed here.

Disqus_37216b4O

“the Swedish and the general Scandinavian models have a lot to offer we Americans in discovering how to heal our society in general”

Like how to kill ourselves?

Socialist Scandinavia has one of the world’s highest suicide rates. So does Communist China.

Molly_Rn

Sweden established it’s social net because it lost 1/3 of the population to America and as indentured servants to Denmark because of poverty. My family was amongst those (both parents in the 1920’s). How amasing that a government recognized that it’s starving people left and took their braind power and initiative with them and that it was a loss to Sweden. Found this out on a visit to Stockholm city hall. Swedes believe in logam where you get just enough (not too much and not too little) and everyone does well and is protected. Why is this so scary to Americans?

Disqus_37216b4O

Scandinavians have a much higher suicide rate than Americans do.
Just sayin’.

Molly_Rn

No longer true. The US has a higher suicide rate than Sweden based on 2009 and I be it is even higher with our troops killing themselves at such a high rate. Look on Wikipedia.

Sheri

How depressing.

Molly_Rn

But true.

PamelaWibleMD

And we we need to claim the truth as truth. Then we can begin to solve our problems.

Sheri

Amen!

Diane

I am a physician and I was there at the retreat Pamela led this April. We can save each other by speaking and listening to our deep pain. Then we can take it a step further: share our pain and listen to that of our patients who have had terrible experiences with the health care system. Doctors and patients can stop being victims of a system that has changed healing from a time intensive relationship to a revenue generating high-tech industry. Pamela has proven that by collaborating with patients and getting the “mddlemen” out of the way as much as possible we can reclaim the joy and privelege of being healers and make a good living. Enough money to care for ourselves and our families, enough time and space enjoy our lives. Thanks for your courage and your example Pamela.

PamelaWibleMD

I am so inspired by all of you. Thank you for taking on your communities and taking back our beloved profession. Healing health care begins when we decide it is no longer okay to be victimized as physicians. We must first do no harm to ourselves.

Karen Miday

I lost my 29-year-olds physician son to suicide last June. He was a faculty member at Washington University. Ironically, he was being monitored by the Missouri’s physicians health program. In spite of this and in spite of his history of depression and alcohol abuse, he was permitted to work a 100+ hour week as a nocturnist. Wash U has done little to acknowledge his death and has certainly not embraced it as a “teaching moment”. They went so far as to edit the death notice we sent them to remove traces of suicide. Staff from MPHP were the last to speak with my son prior to his death. They suggested he not go to the local rehab facility where he and his psychiatrist had arranged his admission but rather come in to look at alternatives. They seemed pretty oblivious to the desperate state he was in. My hope is to begin an initiative to examine the quality of physician monitoring programs, as I suspect that Missouri is similar to other states in providing both insufficient and adversarial oversight, rather than working in collaboration with impaired physicians and their psychiatric physicians. MPHP never contacted my son’s doctor during the two years they were monitoring him, nor did they make any attempt to set restrictions on his work hours. He was exhausted, and relapsed in a two week leave prior to beginning a fellowship in Oncology. The rehab program He was sent to in 2009 was essentially shame-based. He apparently chose death over being mandated back there. State boards can certainly do better than this. I feel like the system ultimately let him down….and that the institution he committed dedicated service to has dishonored him with its silence. I appreciate what you are trying to do, Pamela. I do not want my son to have died in vain and certainly do not want to lose any more talented physicians because of the institutionalization of shame.

Suzi Q 38

Dr. Miday,
I am sorry for the loss of your son.
Thank you for sharing your story.

Karen Miday

Thank you, Suzi. And thank you for your interest in this critical topic.

PamelaWibleMD

Karen ~ Thank you so much for sharing this publicly. I can not bear the loss of any other colleagues to suicide. I offer myself, my story, and a place for us to share the stories of others who we have lost (or nearly lost). I will do everything in my power to honor your son even in his absence. Let his story be told honestly so that he may save the lives of countless others. There is no shame in the truth. And it is the truth that will set us free.

Karen Miday

Thank you so much for your kind words and actions, The night before my son died I suggested to him that he try to push through his SHAME, that he was suffering from a legitimate
Illness. Unfortunately, he believed that no one in the medical establishment believed this. And as Dike points out, not a single one of his colleagues knew anything about his illness. And, thank you for honoring my son. He was one of the most brilliant people I have ever known….and was also a dedicated and caring physician. My grief is unspeakable. And, I hate to say so, but I sometimes agree with the post that suggests we should direct bright and sensitive young people elsewhere.

Karen Miday

PS. I am a psychiatrist in Cincinnati, OH.

Anthony D

When you have the media and many in society that shows no sympathy for the medical doctors by criticizing them as greedy and heartless, its no wonder that many physicians feel that there locked down on the basement and can’t get out. When individuals read that many are struggling emotionally and financially, they show no pity for these people and think they’re lying.

Equality at its worse don’t you think?

PamelaWibleMD

Sad that we should be vilified. How do you think the public sentiment can shift, Anthony?

Anthony D

Pamela. Watch this on Youtube.
Michael Savage – Discussion about Lawyers and Doctors in Society Today.

I think you like it.

PamelaWibleMD

Where’s the link?

Anthony D

KevinMD is not allowing me to post it. So just high light it and put on search on youtube.

The stigma of suicide prevails throughout our society in every profession, culture and economic status. If we spoke openly about it as Pamela has in her article and work, we can save many lives. Isn’t it worth it to put your own judgement and uncomfortable feelings aside in order to save a life? I lost my 23 year-old sister to suicide and experienced first-hand the shame, guilt and embarrassment my family felt when talking about it. Openly discussing it not only helped me and my own family, but other suicide survivors as well.

Mandy

Debbie Gisonni has put into words just about exactly what I was thinking after having read this post and the comments so far.

Thank you, Pamela Wible and others who are making an effort to tackle this issue, especially in regard to just getting people to start to acknowledge and talk about it. If it were a particularly deadly infection or strain of cancer striking down so many physicians in their prime, there’d be no stigma or judgment about people seeking help, they wouldn’t be afraid of being seen as “weak” or “a failure”. Please keep up the good work. You will never know how many lives you have saved and how many families you have spared from grief, but it will be many I’m sure.

PamelaWibleMD

Thanks. Law too. Wow. Has medicine, like law, lost its soul? It’s the lack of meaning that injures us.

Bruce

Yes, life-meaning is the scarcest “commodity” on the planet, even though it is something that money cannot buy. Vitamin L [Love] needs Vitamin M [Meaning] to work, and vice versa — an extreme example of “psychonutrient synergy”.

PamelaWibleMD

This is getting good. Now I’m going to have to read your book, Bruce!

Bruce

Now, You’re REALLY in trouble!!!

Sherri Vance

Pamela, I appreciated this perceptive article and visited the Ideal Clinic website to learn more about your work. When I saw the book title I thought it was a bit odd, and then saw the racy cover and wondered what to think. Then I clicked the video tab, hoping to find interviews with you or your colleagues or patients about your work…only to find strange videos of scantily clad women partying with speculum tools and a goat. What? I can’t figure out what you’re about.

PamelaWibleMD

The cover can throw some people off, but the book is basically chicken soup for the doctor’s soul. Happy to send you a copy. Really inspiring. Now taught in med schools and undergraduate medical humanities classes. This should reassure you of the movement for ideal medical care that is brewing in America:

The stigma against funlovingness and humor — it is the other side of the stigma against admitting needs for emotional and mental healing. Funlovingness and humor are key sources of mental and emotional wellness and healing in themselves — and of the prevention of mental and emotional illness in the first place. The one stigma reinforces the other. Let’s rid ourselves of BOTH stigmas! Dr. Wible is as courageous in her funlovingness and her humor as she is in dis-repressing the taboo topics of physician suicide, etc.

PamelaWibleMD

From SHERYL SCHLAMEUSS BERGER who could not post, but wanted to share: “The very first doctor, (internist) that I found and remained with for years, committed suicide. I thought he was a wonderful physician, but his business expanded and I know he was unhappy with the overwork and exhaustion. One morning he sat in his car in the garage, left the motor running and exited life that way. His wife, looking for him, went to the garage door accompanied by her very young daughter. She opened the door and the carbon monoxide fumes over came her and the young child–such a sorrowful situation! Their two other young daughters were left without [a father]. I commend you on reaching out to other physicians–having mental health workshops and forming a community bond to help other doctors deal with the grueling demands of their ultra-busy professional lives. Thank you for sharing this article.”

Dale Howard

The GOLDEN GATE BRIDGE is considered the #1 location for suicides. Since being built there have been over 1300 suicides committed with an average of 20 per year. Recently, a sociologist conducted an interview study of individuals who had attempted suicide from the GOLDEN GATE BRIDGE and
survived to talk about their experience. In each instance,
those being interviewed acknowledged that at about two-thirds of the way down they realized that all of the situations in life that had caused them to take their own life were fixable except for the fact that they were plummeting toward the ocean below.

It has also been determined that depression left unattended causes an enzyme to be released at the base of the spine which further enhances the depression mood. Most people are unaware of this phenomenon and hence, by not seeking medical attention find themselves in a downward spiral to the point of suicide.

A statistic just shared with me is that over 19,000 individuals end their life each year with a gun.

I feel compelled to help Dr. Wible get her message out to the public and especially the medical community as there is a great need to help people recognize that life is too precious to discard when there is always a fixable solution available.

DQUser

Wow! All this navel gazing. What I get from my past experiences and this discussion is that when trainee doctors get out into the real world they find that they’re just ordinary mortals like everyone else. Secondly, many hate the conditions under which they have to work but forget that their profession created the conditions and is absolutely resistant to change,

PamelaWibleMD

And the medical culture of cynicism kills creativity.

Bruce

Right you are. And your point points to a general truth. Vicious minorities — the profit-extractors of Big Pharma and of the Insurance Machine, for example — seek to enslave us, but we, the rank and file, the vast majority, acquiesce in our enslavement. Should we overcome our acquiescence, they are toast, and we are free.

Hi Pamela: Thank you for all you are doing to help physicians who are struggling. Your article is powerful and insightful. People are struggling, but sadly are often afraid to seek help. In this country, there is a stigma associated with mental illness that keeps people from seeking help.

PamelaWibleMD

Thanks Edward ~ having these conversations is the first step to destigmatizing mental illness. Thank you for keeping the suicide discussion alive.

bcrigger

Dear Pamela….though I’m sorry that some DR.s find themselves in a state of mind to end their life. I’d like to add a few to that list. Most DR.s feel they are GOD and they have the right to treat like a piece of meat. I have to wonder if they stop to think that the way they treat their patients, we are real people with real feelings and fears. I too have issues that weigh heavy on my mind, being raped by a DR ( this was before the law stepped in requiring a nurse) comes to mind when I thought I was being examined. Three years ago another Dr. ( one I’d like to add to the list) I was being examined and he knew of my fears and even with a nurse watching his every move they “THEY” laughed and I’m crying that i want up. They had me exposed of over 20 minutes smiling at each other. I could not get up by myself due to back issues. But when i did get up i fled as fast as i could. So trusting a Dr isn’t an easy thing to do. These Dr.s that kill themselves is it because they DO NOT trust people in there own profession ? Wow, now that’s karma. stigma associated with mental illness….really!!!!!!! I’ve been labeled that by Dr.s….that is so much easier than trying to understand.

Until Dr.s show understanding and compassion for the pee on’s…. that pay for their services, and get it through their heads they wouldn’t have a practice without patients, my give a damn is busted.

As professionals we can discuss this topic clinically, but we’re not as good dealing with it emotionally if it concerns a colleague or ourselves. This is a valuable discussion.

PamelaWibleMD

Vulnerability is strength.

Mengles

Greatly written article Dr. Wible. Do you know what the circumstances were regarding their attempted suicides? (workload, malpractice lawsuits, etc.)? I understand due to identification issues, if you are not able to answer that. Do you think that when it comes to more “lifestyle” oriented specialties – the risk of suicide is much less?

2) Surgeon – isolation as a woman in a man’s specialty, professional loneliness and isolation. Great family life. All work stress.

3) Internist – Sense of overall meaninglessness professionally and personally. Feeling of being stuck and not meeting one’s potential. Lack of fulfillment in assembly-line medicine. Is this all there is?

I’m sure there were other reasons, but I recall these as the dominant ones. The ONE thing that would make a huge difference for all physicians: Start CARING about one another.

How?

1) Just take a colleague you barely know out to lunch for no reason at all.

2) Check on another doctor across town. Just pop over to say “Hi!”

3) Other ideas?

We need to create a culture of compassion. Random acts of kindness. Simple things.

PamelaWibleMD

Docs in “lifestyle” specialties will not necessarily be less susceptible to depression and suicide because if they choose a field based on lifestyle they risk lack of meaning in their professional lives (see #3 – Internist – above) There are lots students who want to do primary care but then chose specialties for the wrong reasons (lifestyle, money) and then they have a lifetime of dermatology when they wanted family medicine. Not great. Fear-based decisions are often a set-up for lack of deeper satisfaction.

Mengles

Interesting as I would have thought dermatology with it’s relatively 9 to 5 schedule would allow more time for pursuing of outside interests, etc. and thus greater work-life balance.

PamelaWibleMD

Greater work-life balance sure. But if you would rather be a family physician and you end up a dermatologist then you have given up your preferred specialty and that can lead to misery.

PamelaWibleMD

Lifestyle over meaning does not necessarily lead to happiness.

Marian Parrott

Pamela, do you not think many of these docs have actual psychiatric problems that could be treated, in addition tot he stress and ennui? And that these illnesses should carry no more stigma than high cholesterol or diabetes?

PamelaWibleMD

Agree on both accounts.

Disqus_37216b4O

It SHOULD carry no stigma, but it does, and Docs are the worst offenders. Try going into an ER and being treated decently if you have a 12-year-old suicide attempt on your Permanent Record.

If doctors’ mental illness should not go on their Permanent Records, then patients’ shouldn’t either.

Joyce Johnson

I agree on both accounts .

Joyce Johnson

I agree that it should not have any more stigma then having diabetes or high blood pressure but try telling this to the medical board.

Marian Parrott

There has to be a way for a seriously ill physician to take needed leave and come back to work with the psychiatrist monitoring ( and the doctor self monitoring). Obviously physicians with garden variety depression ( and I would estimate that at maybe half) would not come under scrutiny of the board because they keep their mouths shut and don’t get into problems at work.

Sheri

I am reminded by your reply of this quote by the late Joseph Campbell.

“Follow your bliss.
If you do follow your bliss,
you put yourself on a kind of track
that has been there all the while waiting for you,
and the life you ought to be living
is the one you are living.
When you can see that,
you begin to meet people
who are in the field of your bliss,
and they open the doors to you.
I say, follow your bliss and don’t be afraid,
and doors will open
where you didn’t know they were going to be.
If you follow your bliss,
doors will open for you that wouldn’t have opened for anyone else.”

After countless years of a rather brutal medical school system, if one follows a specialty pathway for any reason other than for the love of what they are doing, that is a recipe for a lifetime of unhappiness.

PamelaWibleMD

Unfortunately many students do choose specialties for the wrong reasons.

“Work is love made visible” ~ Kahlil Gibran

Joyce Johnson

Well said Sheri.

Puja

Hi, I’m a third year medical student and came across Dr. Wible’s
article about an “ideal clinic” a few weeks ago and was very inspired to
learn that such a clinic was a possibility. She has sent me a copy of
her book and has continued to encouraged me to find a path in medicine
that will make me both happy and satisfied in the future. In school, we
aren’t really taught or exposed to different ways medicine can be
practiced. Most of our rotations are hospital based, very fast-paced
and with short patient interaction. This is already a set up for a stressful job environment. For this reason (and many more) I
think this article on physician suicide is important to share not only
with current doctors, but also with doctors in training. We need to be
aware of what causes people to be dissatisfied with their job so we can
start thinking of ways to improve the problem. Starting this discussion early (in medical school or even earlier) is key.

PamelaWibleMD

Like Maslow, maybe we should start studying happy & healthy doctors to see what they are doing right instead of having burned out and cynical doctors teaching the next generation of students. Let’s focus on what’s working and inspire each other instead of complaining about what is not working. The price of continuing what is not working is more of the same. Thank you Puja for being open to the innovation and excitement of new models. We really do need to save each other.

Sanford Goldstein

good advice Ive heard is Dont come to me wirth problem…..come to me with solutions! Dr Wible your word is healing in itself

Matt

“Physicians have the highest suicide rate of any profession”

Doctors are the most mentally unstable profession out there? Well knock me down with a feather.

Marian Parrott

It’s partly high rates of mental illness, especially depression and sub-clinical bipolar in these super-achievers. And it’s partly that unfortunately an unanticipated side effect of medical education is that it teaches you to kill folks, including yourself.

PamelaWibleMD

Along the continuum of mental illness, maybe we all have something. Apparently caffeine withdrawal is also included in the DSM-5 so maybe super-overacheivers should be in there too!

Una Paisa

“…I gave them the strength to be vulnerable too”

from my experience working with Doctors, I saw it is difficult for them to “stop being Doctors” and just go back to being human beings; they also fail to realize the many resources they have within reach and the amount of professionals that support their work, all because the EGO and The Doctor status doesn’t allow to reach out and say: Something is not well in me or in what I’m doing or take a pause.

PamelaWibleMD

Agree. Hard to be superhuman and human at the same time.

Bruce

Yes, I believe that even many of the more sincere, less simply egotistical, less arrogant medical professionals feel that they must be “where the buck stops” in terms of stability, which is often interpreted as emotionlessness; that they are letting everyone else down if they fail to manifest only as TOWERS OF STRENGTH all of the time.

PamelaWibleMD

Primary care docs I know are nowhere near the 1%.

Lonely Girl

I “accidentally” (I put it in quotations because I don’t feel like it was accidental) stumbled across this blog while looking for tips on how to study effectively in medical school. I am an IMG who is currently stressed beyond belief and although I am not what I would deem suicidal; the thought of not having to wake up tomorrow morning is a blissful one. I guess you could say that being removed from all of one’s social supports and being thrown into a horribly unsupportive Caribbean medical school environment has multiplied my tendency towards depression about a thousand fold- Reading Pamela’s blog about physician suicide was a breath of fresh air- the way she openly talks about it- I have since read everything I could find that she has written and find myself once again inspired to continue down this hellish path- knowing that at the end of it all I will be able to actually practice as the type of physician that I always dreamed of being. I cannot wait to read her book! Thank you Pamela.

PamelaWibleMD

Spread the love. . . . Call me anytime if you need help.

Carlos Pineda

western medicine dramatically reflects the inadequacies and flat out nonsense pervading contemporary western thought.without an accompanying spirituality the practice of medicine is indeed soul-drainig.
thanks,pamela

This comment I left for Dr Pam at her blog applies here as well so I will copy and paste it over:

Thank you for the help you give to other medical folks who have the hardest jobs anywhere. I love my doctor and I am afraid that she will burn out; she’s got two young kids and took a year off to medical leave that just finished less than a year ago. She seems overwhelmed when I see her every couple months for my med refills.

Frances Ilozue, MD

Great job Dr. Wible. No doubt that you’ve helped us bring some attention to this serious topic. These doctors are the same people who are supposed to bring healing to pts and yet very far from “wellness” themselves. Just feels awesome to know that someone actually cares.

Just wondering if my local medical society or any other group in my community will be open to bringing such a retreat to Buffalo NY?
Worth trying though!

Your story telling skills are fantastic. I read your suicide article out loud and finished it with a lump in my throat. When it comes to suicide…every family believes their loved one is an exception to the rule. It is such a complex issue, yet the unrealistic expectations we place on our physicians starting in medical school has to contribute to their unbearable stress levels. You do an excellent job of describing the trajectory of hopelessness. May your article and continuing work turn hoplessness to hope and help transform what happens in medical schools. And, may physicians all over this nation change the way they practice medicine!

PamelaWibleMD

Suicide as a solution to an unbearable health care system is no solution. These are not isolated cases. There is a bigger story here.

Joyce Johnson

Yes it is and more people need to understand this.

Aman

’m a Dentist, but totally understand what you are saying. I feel at times the profession can be quite isolating and as its always about achieving, hitting targets, being highly professional, and operating, rightly so, at a high level. Then ultimately a few will crack and sadly take their own life. If you add into this health worries/financial issues/relationship problems. It’s clear to see how these problems escalate quickly. I think in the medical fraternity I think we could start by simply asking colleagues if they are ok with a nice big welcoming smile. Mental health issues are so critical it’s a hidden killer and rightly deserves coverage especially amongst physicians. Please all take care of yourselves……it’s all you have….take care.

Aman

I’m not ‘m sorry for the typo

Aman

The whole area of wellbeing and happiness are fascinating. Incomes have shot up yet happiness hasn’t kept pace. Mr Richard Layard at the London School of Economics has a research unit on this topic and feels mental issues are woefully undertreated. As physicians and healthcare professionals the irony is we know exactly what we need to do yet uptake seems poor. I would like to set up non judgemental, confidential, informal meet ups with colleagues where only smiles and warmth are the only rules. Then we’ll begin to scratch the surface beneath which is a critical issue both amongst physicians and the wider society, that of mental wellbeing and happiness.

PamelaWibleMD

Great! When should we start?

Joyce Johnson

Yesterday would not have been to soon.

Bruce

Yes, escalating incomes, but “enjoyed” in isolation, like the “enjoyment” of a Count self-imprisoned in his counting house, do not make for human happiness. Human beings are communal creatures, with communal needs. Life-morale requires a thriving web of relationships in which each participant feels contributory to that thriving, able to act to contribute to the whole, to the common weal — not impotent / restrained from positive action. I gather that physicians, increasingly enslaved to the Molochs of Big Pharma and the Insurance Machine, are increasingly denied these communal EMOTIONAL REQUISITES of human health and happiness. Vitamins A, B, C, D & E… will not avail if Vitamin L(ove) is lacking!

Dustin Salzedo

Call a crisis/suicide hotline and ask for referrals for treatment of suicidality, hopelessness, feeling like a burden, ostracism, etc., and you will be summarily informed that there are none (suicide is not a recognized disorder). Get treatment for any form of emotional distress, and your healthcare will be compromised as far as your EHR reaches (ex: surgical resident wrote solely “hx of psychopathology” and failed to note s/p appy in PMH/PSH for acute abdominal pain found to be drug induced hepatitis), or as reported, your license may be placed in jeopardy. And you will be ostracized and forever treated as a tainted “other”.

The now dormant WordPress blog, Incompatible With Life, tried to address treating suicidality’s root causes, and the Reading List page includes references of effective treatment, relevant theory, research and clinical resources.

I think help for licensed healthcare professionals needs to come in the form of confidential, non-reportable support groups in both physical and cyber space, available 24/7 to speak with others knowledgeable about the distress, the means to minimize it in the immediate, short term and long term, and in protecting the affected from exposure, censure and punishment (loss of civil rights, not to mention professional licensure are only 2 among many real likely outcomes of “seeking mental healthcare” – trauma from being the recipient of it and its attendant “leers, jeers and sneers” exacerbates already unbearable psychache).

What we also know is that receiving extant recognized treatment results in dismal outcomes. Our best option is to create a venue where free discussion and reduction of causative distressors is the accepted norm.

I applaud the author and commenters, and I hope we move forward to support, protect and help our fellow physicians, nurses, and therapists.

PamelaWibleMD

Thank you Dustin. I agree that we need confidential 24/7 support that is non-reportable. I think we can all be there for each other in nurturing and non-competitive ways every day. Random acts of kindness among medical professionals would also go a LONG way to help our collective morale.

Funny story regarding suicide hotline: My cousin’s husband was suicidal as a teen in the Bronx. He called a suicide hotline in the 1970s. They told him to “try yoga” He’s been a yoga teacher for over 30 years – before it was even in style. Love that story.

Sheri

Dr. Wible, why isn’t there a confidential 24/7 support that is non-reportable for the medical profession? Why are you ostracized when you as physicians/healthcare workers, need healing?

PamelaWibleMD

Part of the flaw of reductionist medicine. Viewing the human body as an emotionless machine. Being vulnerable and needing mental health care has been seen as a weakness in medicine. Thankfully, times are changing-slowly, very slowly.

Sanford Goldstein

i ahvent seen dr larry ganz chime in yet…maybe you shouild contact him Dr Wible see if he has a comment or two concerning this

Sheri

Dustin, I agree completely. Well said!

Disqus_37216b4O

“Get treatment for any form of emotional distress, and your healthcare will be compromised as far as your EHR reaches”

That is very much the case for non-physician patients as well. Even if it was a misdiagnosis and the patient contests it, it will be a black mark and no doctor will ever treat you like a normal patient ever again.

Doctors should stop treating patients who have that particular “black mark” on their “permanent record” like sh!t.

Joyce Johnson

Dustin, You 110% right.

PamelaWibleMD

Thank you Sheri. A great reminder.

Sheri

Doctors are heroes, yes!! I agree with your comments, May.

Beth Knudsen

I agree with Dustin. A 24 hr hotline for medical personnel makes so much sense. Thank you Pamela for bringing this skeleton out of the closet.

Sheri

Yes, thank you.

Bruce

Agreed. Perhaps this could best be undertaken by a private, foundation-supported initiative, that would exist outside of the reporting requirements that might be forced upon an AMA-affiliated entity, or a public health entity.

Joyce Johnson

That would be great.

AJ MD

As I have been reading all the comments, this subject has really hit home for many of us. Many have known physician who have committed suicide, or like myself, have experienced depression personally and contemplated suicide as an option. I have communicated with Dr. Wible and she has shined a light on this taboo subject and helped me realize I was not alone and there is support out there. I believe the frustration of trying to practice good medicine and battling the insurance machine that limits what we can do can lead to feeling powerless in helping people who come to us for help. The posted comments show that we are not alone in this situation and we can help each other. Hopefully physicians can eventually feel safe enough to get this help without fear of being stigmatized.

Sheri

“I believe the frustration of trying to practice good medicine and
battling the insurance machine that limits what we can do can lead to
feeling powerless in helping people who come to us for help.” AJ, I am not a doctor, but I watched Michael Moore’s documentary called Sicko. I cannot even begin to imagine having a profession as a doctor and having to attempt to help heal your patients according to the dictates of the insurance machine. I had a family doctor in Arizona who told me he was brutalized by medical school and barely made it out alive. He said they tried to kill his soul. He has a family practice but does not take insurance because he doesn’t want to work his medicine according to their dictates. That makes it a hardship for patients and for him but that is how he has to doctor according to the guidance of his heart.

Joyce Johnson

It’s a shame doctors can’t be doctors but prisoners to the insurance companies

PamelaWibleMD

Suffering in isolation is part of the problem. It is fantastic that we are finally sharing out true feeling with one another. So cathartic.

Beth Knudsen

I guess I was in the minority – I had no idea of this problem – until Dr. Wible (via my md daughter) brought it to my attention. I’m so glad you all are talking about this issue. Hugs to you all and thank you for your service.

Sheri

Agree, I had no idea either.

Frances Ilozue, MD

That’s because docs are very good at what they do, which is “hypocrisy”. We always encourage our patients to be honest and open about their health issues but that hardly happens when the table is turned around.

PamelaWibleMD

the sad irony.

Joyce Johnson

I wonder why? Could it be because they could lose their rights to practice

drjrooke

Thanks for bringing this into the light Dr. Wible.

PamelaWibleMD

They call me the “Dr. Kevorkian of medical taboos.”

Bruce

It is so amazing what one honest, courageous voice — despite the terrible rarity of such voices, and despite all the efforts of the AMA, Big Pharma, the Insurance Machine, etc., to drown them out — can catalyze!
Kudos to you!

PamelaWibleMD

Bruce, you have just added your honest, courageous voice to the discussion. And “never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has (Margaret Mead).” Keep talking Bruce. Keep talking.

Bruce

Will do!

Joyce Johnson

Good job doctor Wible.

Sanford Goldstein

when they lift all these useless regs and restrictions…and let doctors heal ther sick then doctors will stsrt to heal as well..right?

PamelaWibleMD

Right. I think so.

Frances Ilozue, MD

That needs to happen soon because at some point it will be impossible to turn things around.

Joyce Johnson

Then you and every doctor that feel like this need to start taking a stand now. Step out on faith.

PamelaWibleMD

“They” lift these useless regs and restrictions? Who is they? How about we break free from the chains that bind us? Only we can liberate ourselves. And it is the truth that will set us free.

Joyce Johnson

All doctors need to stand with you and what you have done .

Joyce Johnson

So true.

Sanford Goldstein

Cont…. case and point is…When you lose the humanity in which the doctors heals…sometimes it just feels useless….I want the person who fixes me to care as much as I do about me… I want to be the most important thing in that room at the time…ME not a stat or a number.
we need to find a way to let the doctors know what they do is for good cause and reason

Sydney Ashland

Yes, and i want the person who treats me to care about themselves as much as they care about me. only then can I trust them with my most intimate issues.

PamelaWibleMD

Yes!

Joyce Johnson

Real Talk that is why I have the doctor that I have you are not just a number to him.

Sanford Goldstein

Im impressed with the comments and directions given to help..i suggest keep doing what youre doing and it will work…I am not devils advocate but not everyone will see or heard this in time…and hope there will be a time when the ideas here will be mainstreamand help the doctors // like ideal medicine clinics that are popping up

Sanford Goldstein

may i make a weird suggestion…Dr Wible you have designed a community base type work environment for the good of the “people” where they feel cared for and nurtured so to speak….Is there no way to crreate the same IDEAL MEDICAL PRACTICE but based of the same fundamentals you want in suggestions from the summinity but from the doctors./ IS that beyond the capcity or is the feild just so mired that whateber suggestions and directions done and suggested would be pointless? I guess I am asking ..you put together offices based on community output…can up design practices and ones based on DRs input?

PamelaWibleMD

Yes. Doctors have attended the town halls and contribute to the clinics as patients. I just attended my first town hall as a patient. It was a blast! Also the doctors in solo or private practices have more autonomy to design more humane and ideal clinics. Community-designed ideal clinics are generally created by community members and patients and run by a solo doc.

PamelaWibleMD

I live for “weird suggestions.”

f. lusu

the American Foundation for Suicide Prevention website has clips from two films that were on nationwide PBS stations- ‘struggling in silence: physician depression and suicide’ and, ‘out of the silence: medical student depression and suicide’.

PamelaWibleMD

I have the films. Focus is on litigation distress and on getting back on psych meds as I recall. I need to watch again. There are deeper issues that are not dealt with in the film. I think the film was partially funded by Pharma.

Bill

People’s responses vary when I mention physician suicide. I guess I should start taking notes. Is this a canary-in-the-coal-mine warning of a trend; or individual events unrelated to any big picture. Either way, it is time to de-stigmatize mental health issues.

PamelaWibleMD

Canary-in-the-coal-mine warning of a trend. The trend is here.

Frances Ilozue, MD

De-stigmatizing mental health has to start with the physicians, otherwise all hope will be lost on this issue.

Joyce Johnson

You are so right,

The New Voltaire

Thanks, Dr. Wible, for caring. I have a few questions. I get the impression that in this venue we are talking primarily about male doctors. Is that correct? I believe the percentage of all female doctors is somewhere between 30 and 40 percent of the profession at this point. Correct me if I am wrong. Are they experiencing the same depression/suicide phenomenon to the same extent as the males? Any numbers out there? What about the statistics for nurses, who are in the same profession? If we can get a closer look at the demographics, we might get a glimpse at root causes.

PamelaWibleMD

Female docs 33% of current physician workforce. Female medical students at 50% or so of incoming classes. I have found women physicians (and male psychiatrists) are generally more likely to ask for help. Ya know men don’t even like to ask for help when they are lost in a car. Gotta be hard for a male physician to ask for help. Guns are more easily accessible than mental health care in the US anyway: See article below – America: 350,000,000 Guns, 47,000 Psychiatrists

Most people with guns do not kill themselves. And if they were intent on killing themselves, and DIDN’T have a gun, they’d just find another way. Japan, with almost no guns, has a much higher suicide rate than America.

What is the suicide rate of physicians vs. gun owners? I’m thinking I know who needs the shrinks.

PamelaWibleMD

I’m so confused. Who?

AJ MD

Some figures I read is that female physicians are close to their male counterparts in suicides per year and they are 4 times more successful than non-physician females. In my experience both personally and with practice partners, we commonly treat ourselves with sample medications or partners calling in prescriptions for antidepressants without proper monitoring by a psychiatrist. Another example of staying in the shadows out fear of exposing any flaw or weakness.

Frances Ilozue, MD

AJ, fear is the “killer factor” and unless we overcome that and start acting like humans rather faking gods, nothing will change.

PamelaWibleMD

Physicians are some of the most fearful people I have ever met. Afraid to stray from the group. Afraid to stand up for what they believe in personally. Time to take back our profession by caring for ourselves, mind, body, and most importantly–soul.

Joyce Johnson

Yes it is and it’s time to stand as a group and have your voice heard.

PamelaWibleMD

Completion of suicide is easy for docs. Drugs are easily accessible and many chose to complete the task at work right in the hospital.

Joyce Johnson

Such a shame you all have to live this way hiding your feelings.

Andrea Schaerf

Most licensing boards allow for rehabilitation from psychiatric illness. There may be a temporary suspension but thats better than suicide.

PamelaWibleMD

Yes. But many docs fear having to tell all to the Board. It can be an onerous process. Those with suicidal thoughts are not always thinking clearly either.

Joyce Johnson

Why should doctors have to have temporary suspension of their license I don’t know of any other profession that has to surrender their license if they suffer from depression..

The New Voltaire

A quick 20 minutes on the Internet, and I found the following information:
1. A lack of good statistics on the subject
2. Medical, dental, vets and farmers have easier access to the means of suicide and know how to use them, i.e. guns and drugs
3. Causes mentioned: Isolation; high divorce/separation rates; poor integration outside of the profession, mostly due to time constraints; alcohol and drug abuse but can’t enter therapy for those without endangering their job security; disillusionment and dissatisfaction with perception vs reality of their profession; difficulty adjusting to sea changes within their industry; loss of personal power and autonomy; loss of status
4. Newer generation of medical students, interns, residents having difficulty adjusting to antiquated, patriarchal power structure of medical academia.

PamelaWibleMD

Great compilation. #4 really hits home. Moving from a patriarchal health care model to a partnership model is not easy for all. Highest risk group for suicide: older white men.

Bruce

Moving from the authoritarian model to the partnership model seems, to me, to be the key to “healthcare system healing” for both physicians and patients, but those imbued with the old model will be at risk, and in need of heightened levels of help.

PamelaWibleMD

Definitely time for a paradigm shift. As a patient, how do you think we can transition best to the new model?

Bruce

I think that your bottom-up, grass-roots, community-designed clinics approach is the best strategy for this transition.

If this movement grows into a tsunami of change, as it should, the plutocracy will attack, and this movement will have to learn how do defend itself against the attack of the most powerful. But that is only to be expected.

PamelaWibleMD

There is nothing to attack. Love and justice are inarguable truths.

PamelaWibleMD

unarguable.

Joyce Johnson

Good reply Dr. Wible. I will say it again we need more doctors like yourself.

Bill

Stress is increasing! Autonomy vs. bureaucracy at the least! Stress occurs when there is an imbalance between demands to be met and the individual’s resources – skills, abilities, time and energy. If the stress continues, the individual is likely to become demoralized and effective problem-solving is unlikely. Consciousness raising is the first step in any effort to deal with the problem. Dr. Wible, thank you for taking that step!

Well said, Pamela! The medical field needs to start realizing that addressing emotions is not fluff, but is absolutely essential for providing high quality care – and creating happy and effective physicians.

PamelaWibleMD

Holistic care needed.

Bruce

Indeed! I also have come to see the practice of meditation as a key to overall human health. From my particular history of experience, I “prescribe” Kriya Yoga.

Kris Parnicky, MD

What I remember from my days in practice was how difficult it was for me to live with the knowledge that I would inevitably make mistakes, and the stakes seemed so high. Discussing that issue was what I wanted in a physicians’ group. It may actually have been available: I never looked. And I never took the initiative to start one. Perhaps this is a place for me to be in service to myself and others.

PamelaWibleMD

We need more safe havens for physicians to debrief and discuss their feelings. We are on the edge of life an death daily. We can not go at this alone in isolation.

Sydney Ashland

Yes, to safe havens to discuss feelings. Turning to anti depressants will not fix this problem. It has to be talked about and shared.

PamelaWibleMD

Drugs are not the answer to dealing with the high rate of physician suicide. In fact, drugs are often the method of choice for physicians who die by suicide. What ails our profession must be discussed openly and honestly. These are not isolated cases.

Joyce Johnson

This is so true Sydney and it not be reported to the medical board.

Joyce Johnson

I agree what would happen if out teachers, fireman ect..suicide rat was as high as our doctors? Well I think there would be a out poring of help offered to them so why not our doctors.

Sheri

Follow your heart.

Krissy

Keep spreading the love, Pamela!

PamelaWibleMD

Will do. Love is the only answer.

Sheri

What healing springs forth from you just writing your article and being here and talking about this. Thank you.

ltimberlake

Wow. I’m glad you’re there for the doctors in need. I wish the ‘system’ didn’t make it so hard to ask for help.

Sheri

It seems very odd to me that most everyone else in society can ask for help if they are in dire straights, but this one segment, doctors, cannot or it will jeopardize their positions, standing with the medical board, etc.

PamelaWibleMD

I am currently reviewing state by state the medical board questionnaires that docs must complete before getting/renewing a medical license. In some states you must check a box if you have ever had the following:

Seasonal Affective Disorder
Hypomania
Bipolar
Depression

AND you may need to appear before the Board if there is any derogatory information (any boxes checked must be fully explained, often in person)

I know physicians who have had their licenses delayed 6 months or longer because they sough marital counseling. They had to get the records from their marriage counselor who was no longer in practice and therefore had to go find someone else to certify that they were okay.

What other profession is so scrutinized for being human?

Joyce Johnson

It’s a shame they are not looked at like lay people. they are human also.

Joyce Johnson

Such a shame because doctors are people with feelings also.

Sydney Ashland

just heard of another med student who tried to kill themselves. so sad. Thanks for being there to draw attention to the tremendous needs here.

Sheri

So sad.

Kathryn

Pamela, Awesome work!

Sheri

Kathryn, I agree with you.

Jennifer

Suicide is not just an individual action; it occurs within multiple social networks (professional, personal, work) and so there are many people affected by each incident. Every suicide which does not happen “saves” multiple lives, so this is a topic very worthy of public discussion.

Sheri

We are all connected by our humanity. What happens to one, affects us all. For lay people, when the healer is so broken suicide is the answer, well, that sends shock waves. These are the people we turn to when we are broken, when we are in need of repair. Who do we turn to if the healers are broken by the very system that created them?

Joyce Johnson

I agree with Sheri. It effect all of us because My doctor is a lot like Dr. Wible and it would be hard for me to lose him and have to build a relationship with someone else.

Guest

Physician-suicide awareness is a paramount step for those who are suffering to reach out for help. Your life can be saved! You can rekindle that sacred doctor-patient relationship; you can remember why you fell in love with medicine in the first place! Pamela is doing it. Reach out to her. She will help you.

Sheri

I have read her book, Pet Goats and Pap Smears. It is one of the ways she is reaching out. It is fantastic. It made me laugh and cry. It is medicine of the highest calling. Medicine of the heart. It gives me hope in medicine, when reading the news and hearing these stories makes it so dim. It is the light at the end of the rather dark tunnel.

Joyce Johnson

I also read her book it was so good I had a hard time putting it down to go night, night.

Joyce Johnson

I agree with guest doctor Wible will help she has a heart of gold.

PamelaWibleMD

Seriously. Call me anytime if you want to talk. 541-345-2437. No need to suffer. I repeat. No need to suffer.

Michelle Smith

Thank you for bringing this topic alive!

Sheri

Yes, thank you.

Jennifer Bailey

Let’s all keep this subject public.

PamelaWibleMD

Jennifer, please forward this article to others – especially med students and doctors.

Sheri

I would love to see this on the front page of all the major media, I would love for everyone to understand what is really going on behind the scenes of “healthcare” and how it affects them and society in the short and the long run. As I write this, my sister tells me that the doctor she worked for, shot and killed himself in the 80’s.

PamelaWibleMD

These are more than statistics. These are loving doctors with patients and families. Just lost a 4th-generation obstetrician last week: Philip Henderson, MD – RIP

Sheri

Yes they are. I read the story yesterday about Dr. Henderson. It was heartbreaking. RIP Dr. Henderson.

Joyce Johnson

Let’s give our doctors a place they can go or someone they can talk to it not be reported to the medical board so we. don’t have another doctor taking his or her life.

Joyce Johnson

Sheri, I agree with you This need to be made public so people will understand what most doctors have to deal with.

Sheri

Agree.

Bea Taylor DO

To all the people who don’t have sympathy for suicidal physicians: first of all, anyone who has no compassion for a person who feels suicidal, regardless of who that person is, what walk of life they are from, or what profession they are in, needs to reevaluate their humanity.

Secondly, most people have no idea of the number of hours, the debt, and the pressure cooker that it takes to make a physician, or that physician suicide rates are higher than other professions. A physician is trained on 3-7 or more years after 4 years of medical school, and usually after another 4 years of undergraduate work at double or more the hours of a full-time job, with a recompense of about $10 an hour, constantly battling ignorance, illness, suffering, and death in order to help people improve the quality of their lives–it is emotionally, mentally, physically draining. We often go without sleep, without meals, without the succor of our families, missing school concerts, missing holidays, spending hours in meticulous surgeries, making decisions that, gone awry can have instant repercussions for people and their families. We are the first ones to talk with grieving families about the lives that could not be saved. We are the first to tell a human being that he has cancer and that he will die in several months. We counsel rape victims and victims of violence as the come to the ER in pieces; we tend the wounds of the abused. We see the ravages of disease and of violence first hand. And we are sued whenever there is an opportunity. We treat people from all walks of life, with all types of attitudes, with an ethical obligation to a patient’s best interest, and rarely the compensation that matches the hours or investment in time–many invest over a quarter million dollars just for the education with student loan payments in excess of $3000 a month. If you want to make money, being a physician is certainly not the easiest way to do it. The personal sacrifice is far beyond what most people realize. It is a privilege to be a healer and it is also a tremendous responsibility, often thankless. Because we do it, doesn’t mean that we shouldn’t also hold to our own human and family needs. Physicians take home less per hour than the plumber who fixes your bathtub or toilet. Anyone who compares it to cake clearly has no idea what sort of crucible medicine can be.

True. I recently billed $135 for an appointment and the insurance company called to offer me in-network status and a reimbursement of $41. Medicaid payments in California are $11 per visit for the sickest people who need the most services.

Sheri

Yikes. You could make that kind of money in tips at your favorite restaurant in one evening.

PamelaWibleMD

I know. I have made that much in tips. Funny thing: Now getting tips as a doctor.

Sheri

That’s because you offer great service.

r58black

Much tipping goes on in western and eastern Europe with regards to health care. It is unreported but still falsely positively impacts outcome when expressed as a percent of GDP.

Joyce Johnson

Sheri I agree with you, I have a friend that wait tables and most days she make 50-60 dollars a day in tips and guess what most of it does not get reported as income. I am not saying that is ok.

PamelaWibleMD

Thank you Bea! This from a third-year medical student in Oregon:

“As a person who has lost everything to pay for the medical bills of my premature daughter, as a woman who worked waiting tables, bartending, and as a florist, and now as a medical student–I respectfully disagree with comments [that suggest doctors are greedy, rich, self-serving]. The rising costs of medical care didn’t come from the greed of physicians, but the greed of insurance and pharmaceutical companies. You won’t find a physician living in a $20 million dollar home, but those homes are full of pharmaceutical and insurance moguls. I’m entering my third year of medical school (only halfway done) and I currently owe $142,000 at 6.8% interest. I could get an auto loan for a better interest rate. I struggle to live on $13,000 a year while attending school and worry how I will pay for my daughter’s after school care. I lose sleep at night wondering how I will pay back this enormous amount of debt on the salary of a resident physician ($35 – $40K). This would be a great salary if I didn’t graduate with the debt equal to a mortgage. I will be at least 30 years old before I can practice on my own license. Ar age 30 I will finally have a ‘real job.’ No savings. No retirement. I don’t own a home. Here’s a great article: http://www.er-doctor.com/doctor_income.html “

PamelaWibleMD

She continues: “As I said to my hair stylist last week: ‘No job is more important than another. For the doctors that think their profession somehow makes them better I would like to see them grow their own food, build their own houses, fix their cars and drill their oil. We are all interdependent and need each other to have a community.'”

“So please be nice to your doctors. I don’t know any one of my classmates that are going into it for the money. We give up the better part of our youth, sacrificing a depressing amount of time away from our family and friends and often our own health to care for you and your family. Every life lost to suicide is tragic, and physicians deserve the same empathy you would award anyone else.”

Joyce Johnson

I agree 110% with Dr. Wible.

r58black

RE: “No job is more important than another”

RESPONSE: That is Soviet slogan bullshit. It has often been cited along “studies” that use a public voting technique to decide how much doctors should be paid (yearly by the way….not per hour as it correctly should be in such accounting). If one wishes to retain their human dignity it almost always calls for that person…any person… to optimize their independence. One can optimize their independence and still recognize interdependence. But to conceptually attempt to place interdependence above importance as compare to optimizing one’s independence is nothing more than a recipe for collective decline.

PamelaWibleMD

I don’t think she was recommending we all earn the same wage.

Sheri

Thank you, Bea, for setting the record straight as to where so much of the problem really lies today. With the pharmaceutical and insurance industrial complex. Of course, the problem is much more complex than that, but they are the visible ones. Your story is mind boggling. What you are your peers are going through to work as doctors is inhumane. I wish it were not so. Thanks for sharing your story. It is very impacting.

Joyce Johnson

As for the insurance industrial the don’t want to spend money only make money not even when you have paid insurance for years and get sick they want to know how long will you need to stay in the hospital or need to go see your doctor. And a doctor should not have to call the insurance every 3 days to get it approved for you to stay another few days, That is time he or she could be spending doing something else.

Sheri

Joyce, Michael Moore laid it all out for the world to see in his documentary called Sicko. If you haven’t seen it, I highly suggest you do. It appears the insurance companies are the ones who call all the shots when it comes to medicine. Whatever makes the most profit for them and their share holders…..human illnesses are just the way they make their big money.

PamelaWibleMD

Physicians don’t need to cower in the corner.

r58black

No. They need to grow their kohonos back. They need to assert their right to exist as individuals in a sustainable manner (as any and all should do regardless of profession). They need to use their middle fingers more…and I don’t mean for exams.

r58black

Michael Moore is a hypocrite opportunist. Talks about how great Cuba is…which it isn’t (they drastically fudge their infant mortality statistics by redefining what an infant is)….and Mr. Moore somehow seemed to avoid checking into the worker’s paradise south of Florida when he sought treatment for his weight issue. Insurance is a necessary evil against catastrophic major medical events. It is not a prepaid health plan. The public stupidity of actually believing that they can legislate to give things away….marked the end of accountability, reality and the beginning of the end of this country’s glory days. The main forces driving this evil are looting (expecting something for nothing and/or at less than fair market value)…a.k.a. entitlement…..and the lying politicians who legitimately but immorally use legal plunder to steal the goods and/or services of others.

Sheri

Calling Michael Moore names does not change the fact that the main focus of insurance companies is for profit, to keep their shareholders in the 1%. Decrying Michael Moore does not change the fact that our health care system is driven by the dictates of the insurance companies. Medical treatments you may need now or in the future, healthcare you receive, is decided upon by your insurance company. If you are costing them too much money, you will more than likely be dropped from the policy you have been shelling money out to for many years. Regardless of Michael Moore’s flaws as a human being, insurance companies and pharmaceutical companies are at the root of our broken health care system.

Joyce Johnson

Now that is real talk and I have said that for a long time.

r58black

Actually and factually the rising cost of medicine is mainly due to the cost of technology. Regarding the “greed” of pharmacy companies I feel compelled to enlighten you.

Currently, it costs about 800 million dollars to get a drug through the research and development phase and then to market. In addition, only one out of 20 drugs finally make it to market. That means that for every successful drug that makes it to market the research and development cost of this success is actually 15,200,000,000 (fifteen billion and two hundred million) dollars per successful drug. However, at this time, due to the lack of restrictions against artificial low pricing acceptance by U.S. pharmaceutical companies who contract with buying entities outside of the U.S. jurisdiction, that cost of the $15,200,000,000 is actually being borne almost solely on the backs of the U.S. consumer. And, as well, the consumers of the pharmaceuticals sold to those entities outside of U.S. jurisdiction ALMOST ALWAYS DO NOT pay for the research and development costs of the pharmaceutical that they are now benefiting from that came to fruition from the costs almost fully funded by the U.S. pharmaceutical consumer. PLEASE NOTE THAT THE ESTIMATION OF THE $15,200,000,000 DOES NOT EVEN INCLUDE THE PRODUCTION COSTS so this assessment is most likely an underestimation of the actual costs involved. In other words, it is more probable than not that the U.S. consumer is actually paying even more than noted above for the majority of pharmaceutical research and development.

Essentially, the U.S. consumer is being forced to now pay for most of the rest of the world’s costs of the research and development costs of these pharmaceuticals. If this burden upsets you then please contact your appropriate federal representative and tell them that you think the rest of the world needs to pay their fair share of the research and development costs of these medicines.

Regarding the “greed” of insurance companies….much of that has to do with the sheepish majority that actually thinks that wishful thinking is reality…i.e. that insurance is a prepaid health plan. Adding to this wave of childish thinking is the lying politician who would promise anything to get elected…including stealing from others. Further compounding this evil is the application of ERISA to health care by the thankfully now dead Dick Nixon in which tyranny – i.e. control of a process without responsibility for controlling the process- was actually legitimized. The additional tyrant tactic of deny, delay, defend….or hire penny per hour peons (one company even used prison labor at 80 cents per hour) to argue with the provider over medical necessity…..while the provider and/or provider staff so being argued with gets paid squat…shit…shyte…nadda….for engaging with said peon….which further increases the negative overhead impact of the provider but not the income of the practice….therefore….further decreasing the sustainability of the practice…..unless the providers simply just submits and does what they are told to do…including getting sued for the failed results of any implicit orders of an outside, stronger party……..but not in any way significantly impacting the carrier and/or their minion subcontractor’s overhead….as the carrier can simply just increase their premiums next year in what is essentially a rigged game. Its quite simple. The American dream has become one of simply buy off and/or do enough donation to the political person you need…..act outwardly civil, humane and official….hide one’s true tyrannical nature….shield one’s self from accountability by any and all means available…..distance one’s self from the front line by having a large significant buffer of peon pawns between you and the customer….and giving good public power point presentations to justify it all as well.

PamelaWibleMD

Where did you get the 15 billion #? And WOW!

” . . . (one company even used prison labor at 80 cents per hour) to argue with the provider over medical necessity . . .”

Did this really happen? Where? Which insurer?

Kassy Daggett

Yet another well thought out assessment of the problem. What might you
write if you put the same amount of time and energy in pursuit of
solutions? I’m inspired by the passion that has been activated by this article! Anything is possible if we turn it around and look towards solution!

Joyce Johnson

And doctors never stop going to school because there is always new meds or new ways for treating the same thing what was good ten years ago is not good today.

Kassy Daggett

Nicely stated Bea! Very thoughtful comment!

Sheri

Michael, your letter frightens me, sheds light on the deeper issue going on. This sounds like Nazi Germany. I haven’t read the articles you linked here, but I will. I am not a doctor, nor am I in the health care profession. However, your article has a profound effect on me. I have read through all of these threads off of the original article about physician suicide. Your letter resonates the deepest as to what is underneath the reason a physician would resort to committing suicide. I would not want to work under the thumb of the tyrant. Are people entering medical school made aware of these laws by which they will be subjected their whole life as a doctor? If you are a doctor, is there a way to work outside the jurisdiction of the tyrants?

PamelaWibleMD

Michael – how long have you known of this?

Michael Langan

“They see it as sort of putting the inmates in charge of the jail.”

-Jim Jones

It does not take a great deal of critical analysis of the ASAM, FSPHP, and State Physician Health Programs to show that these organizations are “front groups” for AA.

My view of AA and 12-step treatment is that it is a useful modality for many people to overcome addiction. I have referred patients to 12-step and and applaud those who have been helped by this system. I view it through the same pluralist lens as I do religion-“there are many paths to salvation or liberation, and none of them is superior.”

Foisting an exclusivist approach that only 12-step doctrine has the true path to salvation on a patient would be unthinkable. Unfortunately, as a front group for AA that is what is happening to any doctor who is referred to Physicians Health Service. Forced religion one size fits all coercion and indoctrination under threat of loss of licensure.

The goal of the ASAM is to be recognized as the “experts” in addiction medicine. They are not. The American Society of Addiction Medicine (ASAM) was started by Dr. Ruth Fox in the 1950’s to promote AA and the 12-steps to doctors as a treatment for alcoholism. The American Medical Association had previously reviewed the Big Book in 1939 aptly finding it “a curious combination of organizing propaganda and religious exhortation” that “contains instructions as to how to intrigue the alcoholic addict into acceptance of divine guidance in place of alcohol.” The reviewer concludes that other that the “recognition of the seriousness of addiction to alcohol” the “book has no scientific merit of interest.” Unable to convince the medical establishment of the scientific merit of 12-step philosophy as the sole treatment for addiction with propaganda and misinformation they came up with a better idea. By controlling the regulatory, political, licensing infrastructure of doctors they could take by force what they could not by persuasion. Thus began the creation of the American Society of Addiction Medicine strategic plan declare themselves experts, get the necessary targets to perceive them as experts, and usurp evidence based medicine, individual freedom of thought, personal liberty, and reason by getting themselves declared experts. A symphony with one note. Twelve-stepping gangs having only a hammer seeing everything as a nail.

Like the National Council on Alcoholism and Drug Dependence (NCADD), an organization that promotes the AA agenda yet claims to have no formal ties to AA, the ASAM and FSPHP are front organization set up and controlled by AA.

Both the NCADD and ASAM were set up by groups of AA members to promote AA and its core beliefs (especially the disease concept of alcoholism, the absolute necessity of abstinence for anyone who has ever abused alcohol, and the AA 12-step program as the only means of recovery). The two were combined for a while but NCADD is the “educational” front for AA and ASAM is the “medical” front. A long term goal of AA has been its acceptance by established medicine as the only valid method.

ASAM certification does not indicate expertise . It is a sham specialty bestowed for the appearance of erudition, expertise, and education. It is not recognized by the ABMS but are lobbying fervently to achieve that goal. To prove a point I took the exam and passed it by a large margin. Yet the propaganda and misinformation that they have spread over the past decade has accomplished the goal of perceived legitimacy. As “the new voice of addiction medicine” they have heavily promoted the concept that they are “experts in addiction medicine” and have convinced medical societies, medical boards, and regulatory agencies, parole boards and others to not only accept them as experts, but to write legislation in states to declare them “the” experts in addiction medicine. They did this with a torrent of strategic lobbying efforts on behalf of the 12-step addiction treatment industry towards the AMA (and indirectly through the FSPHP towards the AMA), ABMS, APA, FSMB, ABIM, JCAO, CSAT, consumer groups, presidential candidates, state medical societies, congress, corrections agencies, social service agencies, faith-based community centers, the media and many other targets.

By convincing others of their expertise they have strategically placed themselves in positions of control and influence. By joining already established physician health programs, gaining power, and removing dissenters, they have taken over these programs in each state– united by the FSPHP. So the AA agenda is in control of physician health. The major problem is that the ideology and dogma compromise truth and reason. They have a history of suppressing dissent and attacking critics. Now all they have to do to remove a doctor from practice is obtain a referral, confirm substance abuse concerns or psychological issues by like-minded cohorts in the drug testing and treatment centers, and mandate a monitoring contract under the purview of PHS. It’s all smoke and mirrors but the plan, sinister as it is, worked. Established as the overlords of addiction medicine this control reaches far beyond organized medicine. By redefining the language of addiction and combining “substance abuse” and “substance dependence” under the new term “substance use and addictive disorders” as seen in the DSMV the rampant over-diagnosis and misdiagnosis tactics used by many of the 12-step-drug-testing-rehab facilities will only get worse. Every college binge drinker or teenager caught taking a bong-hit is at risk of being labeled with a chronic brain disease requiring total abstinence, urine monitoring and a lifetime of 12-step recovery.

As a pyramid-structured authoritarian group that uses deceptive recruiting and coercion, fear and intimidation to control, aggressively promotes confidential referrals of others, stigmatizes, demoralizes, and dehumanizes its members into admitting powerlessness, engages in group-think, suppression of dissent, enforced conformity in thinking, has unquestionable dogma, believes the only way to salvation is by following their infallible ideology, engages in deceit, denial, and falsification of psychological and toxicological tests justified by a noble ends-justify-the means belief system should have raised some cult radar eyebrows. It has not.

The fact that a group of physicians, all “in recovery” from substance abuse issues banded together and called themselves an “addiction medicine” society, recruited 3000 like-minded converts, proclaimed themselves a “medical specialty bestowing on themselves sham “board certification,” and proclaimed themselves the “new voice of addiction medicine” even though the American Board of Medical Specialties doesn’t acknowledge them, introduced toxicological tests for alcohol (EtG, PEth) with no evidence base, tested it on physicians being monitored without their knowledge ( in violation of the 1947 Nuremberg Code of Ethics), and marketed it through private drug testing companies should have raised some conflict-of-interest and charlatan hackles. It has not.

The fact that the ASAM physicians have gained power by opportunistically and systematically taking over independent programs for impaired physicians in each state by joining, outnumbering, and removing dissenters, aligning themselves with medical boards, medical societies, and regulatory agencies under the guise of public service and benevolence, successfully deluded political and regulatory powers to perceive them as experts in addiction medicine with common goals, and manipulated state legislature to rewrite statutes officially declaring them experts, simultaneously shielded themselves from oversight, inquiry, and accountability by manipulating loopholes in and perverting “good faith” intentions of health care quality regulations, laws, and guidelines, “peer review” immunity, and confidentiality to build an impenetrable, unseen, and sinister lair, should have raised some red flags. It has not.

The fact that the seeds were planted in the 1980s by a tyrannical prohibitionist architect of the “Drug War” hell bent on winning who recently stated that the PHP model is the “paradigm of substance abuse treatment” and “prolonged monitoring with intensive random drug and alcohol (including EtG and PEth) testing linked to swift” and certain consequences,” the ASAM, FSPHP has expanded from substance abusing physicians to any psychiatric issue, has identified the “aging” physician as a target under the premise that demented doctors are a major health problem, is campaigning and lecturing about the “disruptive physician” and how to identify them for referral by warning signs such as dressing and thinking outside the norm, and that the master plan is to expand this “kill them all let God sort them out” model to courts, colleges, and other professional societies should be a call to arms.

Kassy Daggett

Yet another well thought out assessment of the problem. What might you write if you put the same amount of time and energy in pursuit of solutions?

PamelaWibleMD

Wow! Michael, I had no idea you were so well researched in this area. I had no idea much of this was going on behind the scenes. I think we are just scratching the surface here.

Nima Dinyari

What a powerful Message Pamela. We need to change the direction of health care in this nation and I think this is a great foundational shift in the right direction.

Nima

Sheri

I couldn’t agree more!!

Joyce Johnson

I also agree there need to be some changes in health care.

r58black

IF THE PEOPLE OF THE UNITED STATES WANT UNIVERSAL HEALTH CARE THEN THE ONLY WAY THEY ARE GOING TO HAVE AN ETHICALLY VIABLE AND ECONOMICALLY REALISTIC SYSTEM (UNDER A NON FLAT TAX SYSTEM) IS TO:

1)MAKE THE POLITICAL LEADERS WALK THE TALK-I.E. THEY MUST HAVE THE SAME BENEFITS THAT THEY ARE FORCING UPON THE GENERAL POPULATION,

2)ALLOW ALL UNITED STATES CITIZENS AND TAX PAYING LEGAL RESIDENTS TO GET A TAX DEDUCTION/CREDIT FOR THE PREMIUM OF THE HEALTH INSURANCE POLICY OF THAT INDIVIDUAL’S CHOICE,

NOTE: WOULD REASSESS POINT TWO IF THIS COUNTRY EVER GOT ITS ACT TOGETHER AND WENT TO A FLAT TAX SYSTEM OF A SET PERCENTAGE STARTING ABOVE POVERTY LEVEL, NO EXEMPTIONS… NONE, AND INCLUDE TAXING THE VALUATION OF ASSETS (STOCK OPTIONS, ETC.) GIVEN IN LIEU OF SERVICES RENDERED AND SO VALUED AT THE TIME OF TRANSFER.

3)ALLOW ALL UNITED STATES CITIZENS AND TAX PAYING LEGAL RESIDENTS TO GET A HEALTH SAVINGS ACCOUNT,

4)ALLOW ALL UNITED STATES HEALTH CARE PROVIDERS TO GET A TAX DEDUCTION/CREDIT FOR THE CHARITY HEALTH CARE THEY PROVIDE IN OR ON THE UNITED STATES, ITS TERRITORIAL WATERS OR AIRSPACE AND

5)HAVE TRUTH IN PRICING-I.E. TELL THE CUSTOMER, THE PATIENT, THE ACTUAL COSTS OF GOODS AND SERVICES PRIOR TO PURCHASE IN NON-EMERGENT SITUATIONS.

PamelaWibleMD

Those are some common sense ideas. LOVE #1.

Kassy Daggett

Ditto!

r58black

IF THE PEOPLE OF THE UNITED STATES WANT UNIVERSAL HEALTH CARE THEN THE ONLY WAY THEY ARE GOING TO HAVE AN ETHICALLY VIABLE AND ECONOMICALLY REALISTIC SYSTEM (UNDER A NON FLAT TAX SYSTEM) IS TO:

1)MAKE THE POLITICAL LEADERS WALK THE TALK-I.E. THEY MUST HAVE THE SAME BENEFITS THAT THEY ARE FORCING UPON THE GENERAL POPULATION,

2)ALLOW ALL UNITED STATES CITIZENS AND TAX PAYING LEGAL RESIDENTS TO GET A TAX DEDUCTION/CREDIT FOR THE PREMIUM OF THE HEALTH INSURANCE POLICY OF THAT INDIVIDUAL’S CHOICE,

NOTE: WOULD REASSESS POINT TWO IF THIS COUNTRY EVER GOT ITS ACT TOGETHER AND WENT TO A FLAT TAX SYSTEM OF A SET PERCENTAGE STARTING ABOVE POVERTY LEVEL, NO EXEMPTIONS… NONE, AND INCLUDE TAXING THE

VALUATION OF ASSETS (STOCK OPTIONS, ETC.) GIVEN IN LIEU OF SERVICES RENDERED AND SO VALUED AT THE TIME OF TRANSFER.

3)ALLOW ALL UNITED STATES CITIZENS AND TAX PAYING LEGAL RESIDENTS TO GET A HEALTH SAVINGS ACCOUNT,

4)ALLOW ALL UNITED STATES HEALTH CARE PROVIDERS TO GET A TAX DEDUCTION/CREDIT FOR THE CHARITY HEALTH CARE THEY PROVIDE IN OR ON THE UNITED STATES, ITS TERRITORIAL WATERS OR AIRSPACE AND

5)HAVE TRUTH IN PRICING-I.E. TELL THE CUSTOMER, THE PATIENT, THE ACTUAL COSTS OF GOODS AND SERVICES PRIOR TO PURCHASE IN NON-EMERGENT SITUATIONS.

PamelaWibleMD

Spread the love, Nima . . . . I know you can do it!

NOS

Nima in Tibetan means sun…. my dad and nephews name…

Kassy Daggett

I agree!

r58black

Start with just saying no to the government teat.

Joyce Johnson

Good job Pamela on getting the word out about the high number of suicide among doctors and letting them have someone they can talk to that know how they are feeling.

Joyce Johnson

And what most patients/people fail to remember and that is our dr’s are just as human as we are. They have some of the same troubles that we have and more, so with all that they have to bare within their own minds/soul it’s understandable how they may think that suicide is the only way to “stop the madness” of “end their own private hell”. Again, more dr’s should practice the way you do as well as reach out to their fellow colleagues.

r58black

The private hell differs quite distinctly from the hell forced upon one by the actions of others.

PamelaWibleMD

how?

r58black

Is it not self evident? If one is tormented by a private hell….for instance, severe multiple sclerosis, etc….then that is in no way due to the fault of another individual. If one is stressed out because one is held responsible for processes that are actually controlled by others….a.k.a. being a human shield….then that is the very essence of the lab model of inducing psychosis in primates. If one is constantly and unavoidably plagued by looters/moochers (for instance, legal plunder via entitlement), sophists (argue to win regardless of the truth….may Socrates rest in peace since the Sophists murdered him…..lawyer, liar..sounds alike), tyrants (or their minions…like the ones with a GED bugging the hell out of you and questioning everything you do while they get paid by the hour and they have no f**king idea of the pertinent doctor patient relationship involved)…and/or such individuals who actively ally themselves with such unsavory characters because they sycophantically seek the advantage of authority based on power…..then that could easily be conceived as hellish condition created by others….if one could not escape it.

Kassy Daggett

So glad everyone on this blog roll is reaching out for support in at least this small way by participating in the discussion!

r58black

I would not define all doctors as humans. Having an MD does not necessarily make you human. In fact, there are some MD’s who I view as essentially not human and who are quite a bother to other human MDs.

Joyce Johnson

I’ve worked in the medical field since I came out of high school and what was said in this article was very true. Doctors have one of the highest rates of suicide of professionals. In the past I worked for a health group where one of own physic doctors committed suicide and that is when it became surreal that they have the same problems that we do.

PamelaWibleMD

Weird how patients think we are immune from life’s problems. But they do.

r58black

Many patients place physicians on a pedestal…much like praying to a meal before eating it unfortunately.

PamelaWibleMD

I can understand that behavior in the 1950s, but this is 2013.

r58black

Nothing is new under the sun. That worship before you eat behavior has been around for a millennium. Like the assailant publicly portraying politeness and respect to their target to somehow make their attack valid when it isn’t. Weird but true. In so placing physicians on pedestals….some in the public can and do use this as an excuse to dethrone one from a god like position that the provider of the beholder never claimed to aspire to.

Joyce Johnson

I think doctors should have a retreat like this they can attend at least once a year

PamelaWibleMD

We got room for 50 twice yearly. Next dates: Oct 6-9, 2013 and May 6-9, 2014.

Kassy Daggett

I agree wholeheartedly! We take our cars for regular service! Let’s treat ourselves as well as we treat our vehicles.

Joyce Johnson

Michael I hope you chose another line of work..

NOS

This is an excellent idea. It is needed tremendously. I definitely
graduated from med school with PTSD. It has changed me forever. My
mom’s friend that I have known since I was born saw me for the first
time since I went to med school and she said to her….she has changed so
much….was it worth it? I wish I could change back but I realize that I
will never be the same again..and it isn’t in a good way. We had two
suicides and one murder…and one serving life
in prison for that murder . Yes I went to a hard core school (old school kind of
place). PTSD isn’t benign…it truly affects you to the core…it changes
your brain (check out Nolte for reference or geez…I can’t even remember
the other huge textbook I read so many times). It makes you numb and it
makes you have a terrible memory. I used to have an amazing memory.
Anyway, I try/have tried my best to not let anything affect how I dealt with
patients. I believe I did a good job separating things; but, all along
I was and still am destroying myself on the side so I know it is going
to shorten my career. I doubt I will practice for as long as my father
did (until death) if I practice at all on my own. But, I would never
divulge this information to anyone since I know it is seen as weak.
Believe me if you knew me you would never think of me as weak…on the
contrary…I am considered as a come back kid very resilient….

and I agree…please change medical education…we were so beaten down on
our clinical rotations…I almost dropped out after the first week of my
first rotation in surgery….literally I had the papers ready. I

This blog is helpful for me to read. It makes me not feel as if I am so
alone. I know that there are others that are in the same boat. I
appreciate that very much.

I hope you continue to help physicians like you are doing….even having
access to something to read like this blog helps tremendously. We don’t
always need much….just something every so often…to keep things going.
Thank-you so much for being such an awesome role model. I hope one day I
can be the same.

PamelaWibleMD

Labor of love. I don’t think we can really fix health care until we heal ourselves and stop the abuse in our training. I’d really like to speak with you about what you went through. Please call me anytime.

r58black

As long as a physician disregards their own life as an individual then there will be no significantly healing….only continuance of misery.

PamelaWibleMD

Exactly. Again, can NOT be victim and healer simultaneously. Chose one.

r58black

Learned that one on the playground at a young age. Its a no brainer. I would rather die standing than on my knees….allegorically speaking of course…no offense to any paraplegics, etc. Stealth bullies are a big problem….especially when they engage very nice, civil persons. Best that one hone their radar skills to see through the stealth…and have better early warning regarding the behavior that reveals the bullies true character….once recognized…consider avoid, elude and evade…engage only as necessary….and equally to the task if needed. I have been quite the nasty to some big wigs once it is evident that despite their position and/or academic background that the individual was nothing more than an *sshole (someone who speaks for someone else without that person’s permission) and/or a tyrant (one who wants control of a process but does not want responsibility for controlling the process or worse wants an additional party, a.k.a. human shield, to be responsible for the process the tyrant controls). (And really character isn’t taught in school anyway….or even with CME’s, etc.). You can dress and polish up shyte…but its still shyte. Best tactic of course is to underscore their subhuman behavior before responding with a nasty. If not obvious, I do not adhere to the ridiculous principle of peaceful coexistence. I peacefully co-exist with humans. I prefer subhumans to fear me if I cannot avoid them.

Lonnie Stoner

Your words prove that you are good role modle

NOS

Thanks!

r58black

Is that post testing stress disorder after med school?

PamelaWibleMD

ha

NOS

testing stress disorder after med school….what?

r58black

PTSD…post traumatic stress disorder or post tests stress disorder? Or did you feel refreshed after the barrage of testing in medical school?

Kassy Daggett

You already are an awesome role model by writing this post NOS!

NOS

Thanks for the compliment!

NOS

Keep this going….to all docs out there…you know that this is a serious issue…we have the ability to do amazing things…so comment so that we can hear each others voices…and if we can be better…we can do better.
We all went into this profession to do good…I am a firm believer…how could you possibly pass the stuff we had to pass if you didn’t want it.

Regardless….there is a lot of healing that needs to be done in medicine…and it ..includes physicians…supposed healers…too.

r58black

Healing? Acknowledgement of the validity of outrage would be a good start. Empowerment to the point of insisting upon re inserting reason, fairness and sustainability back into the remnants of the patient doctor relationship or cease to engage in those settings that are no longer reasonable, fair and sustainable. Having the courage to tell bully tyrants to go f**k themselves…diplomatically of course.

PamelaWibleMD

That could be healing. Speaking the truth is a good start.

r58black

Bullies can’t be reasoned with….even with truth. They only understand more force than they can exert.

Sheri

We need you on Capital Hill.

r58black

You mean the District of Criminals. That rotten core will not yield to reason alone.

Sheri

Is there a lobby of doctors in Washington? Doctors that are on the side of the light?

Kassy Daggett

Yes! Anything is possible!

Sheri

Physician, heal thyself. Maybe there is a deeper meaning to this proverb.

Anthony D

A large percentage of doctors will find that they will be unable to survive financially…so many have huge loans to repay from their time in school, and with the 6-digit cost of malpractice insurance thrown in, they won’t be able to pay their bills, let alone make an income…it’s simply an extension of what’s going on now with the way medicare/medicaid programs limit what they can charge, making it necessary for them to depend on other patients’ ability to pay and the insurance they carry…which in turn becomes problematic because ObamaCare or any national healthcare program will severely limit those insurance payments, making it then necessary to charge even more to the patients who pay on their own…and there won’t be many, if any, of those anymore…in short, or severe doctor shortage in this country today will become even more of a problem, and a lot of the treatment now available simply won’t be available from truly qualified personnel
anymore, and thus will become rationed, and of course that will make it even more difficult for doctors…Because they’ll be stretched so thin…

In effect, what ObamaCare does is create a situation in which there will be many fewer highly qualified physicians and a tremendous amount of your medical care will be administered/prescribed by minimally trained/educated/experienced people making, for all intents and purposes, minimum wage…think of it this way…when you go to have
something fixed on your car, you want someone working on it who has a bit more idea about your car than where to put the gas in.

PamelaWibleMD

The answer (in part) is a lot less bureaucracy.

r58black

in a rather large part actually. At least enough to restore accountability.

PamelaWibleMD

Yep. Repeat after me: DISINTERMEDIATION.

Sheri

Does your Breitenbush conference talk about how to do this? I have been pondering the plight of having a $500,000 student loan. I have been wondering how someone who does owe this much can run an Ideal Clinic, see patients for longer than five or ten minutes, talk to patients without their hand on the doorknob most of the visit, see less than 80 patients a day. Is there a system in place for a doctor with a gigantic ball and chain loan hanging around their neck, a way which allows them to pay back the loan by seeing so many patients per month for free? Patients that continually tax the system by going to the emergency room without insurance because they can’t afford a primary care doctor? There has to be a workable, humane solution to this complex problem. Doctors are very important people on this planet. There has to be a way to fix what is so broken.

PamelaWibleMD

Yes. Happy to send you an FAQ that shows how this is done. I got my overhead down from 74% at my favorite factory job down to 10% and so you keep much more of the revenue you generate in this model.

Dale Howard

Wasn’t there a mention in the book of a female physician who got a small town in New York to pay off here loan if she would move to there town and be their doctor? Creative Financing!

Dale Howard

I was impressed with my wife’s doctor, Leigh Saint-Louis, whose website has an appointment scheduler program that let’s you choose the date/time/duration of your appointment. And it even sent you an email confirming the appointment and a followup reminder email. Someone starting out could do the same by adding a calender to their website without all the bells and whistles. Basically, simplifying the procedure saves in staffing costs as I am sure is explained in Dr. Wible’s outline.

PamelaWibleMD

Yes I wrote about that in the book Optimism and they did not pay off her loans, but they did some REALLY amazing stuff for her, FREE office, no rent, remodeled a house for her and her disabled daughter, snowplow her driveway, and help in her office – all for FREE!!

Dale Howard

When you are happy and enjoy what your doing the loans become second nature!

PamelaWibleMD

Depends. If you can’t afford a house and day care for your kids . . .

Dale Howard

Happy implies all is well!

PamelaWibleMD

Yes. Happiness is what we are all after anyway. And love.

r58black

Declare bankruptcy if you cannot sustain due to the deception that you were told prior to entering this profession. Then reassess. Do you want to be a merchant? Do you want to be a serf? Do you want to be slave? Do want to involuntarily do a lot of “volunteer” work?

PamelaWibleMD

Give up the victim mindset. We can not be healers and victims simultaneously.

Kassy Daggett

Yes! It’s time to be part of the solution folks!

r58black

And specifically what does that entail?

Kassy Daggett

A good start is to turn all complaints into requests and take action
that begins to transform the current situation. A step away from the
problem state is a step toward the desired state. Each one of us has
some unique part we can play in our own communities. Begin asking
yourself, what can I do to be part of the solution?

Doctors are like attorneys they are great at their professions but lousy accountants. Corporations hire great accountants but make for lousy employers (money driven). A vicious circle!

Dale Howard

Doctors are like attorneys they make
lousy accountants. Corporations hire great accountants but make lousy employers (money driven). A vicious circle! Also, student
loans can’t be absolved through bankruptcy.

If you’re struggling to pay credit card debt, car loans or even gambling debt, you can wipe the slate clean in bankruptcy. Struggling to pay your student loans? Sorry, you’ll just have to
figure that one out on your own.

In an effort to shed light on a policy they say “doesn’t make any sense,” a group of bankruptcy lawyers issued a report on Tuesday that highlights the need to change the U.S. bankruptcy code so that it offers college grads relief from inescapable debt loads. In the report from the National
Association of Consumer Bankruptcy Attorneys (NACBA), four out of five of the 860 lawyers surveyed said the number of potential clients they encounter with student loan debt has “significantly” or “somewhat” increased over the past 3 to 4 years

Dale Howard

Not to mention that 8 years ago Congress empowered Collection Agencies the ability to collect student loans without prejudice. One person informed Clark Howard (financial analyst) that he started having $200 a month taken out of his Social Security check for a $300 student loan he had over 30 years ago (now amounting to over $3,000). He contends that the loan was paid off. Clark sympathized with the guy but stated that he had a hard road-to-hoe even with proper documentation. There wasn’t even a court hearing to substantiate the Collection Agencies claims (no representation).

Dale Howard

Clark Howard no relation.

PamelaWibleMD

I didn’t realize that student loans were not impacted by bankruptcy. I’ve had physicians tell me that they will never be able to buy a house and will be paying off loans into their 80s.

Renee Liana

Great job Pamela! Spreading the word… Change starts when people start questioning assumptions and joining for the cause. You are such an inspiration. Our medical system is one of the most important areas we need change in in our society! This info is so sad yet brings so much light to the situation. Really opens your heart to doctors. Thank you!!!

PamelaWibleMD

Once physicians can share their pain, patients will have more empathy for them. And we can all heal. Now that’s health care!

Sheri

Amen

Kassy Daggett

Amen Sista!

Lonnie Stoner

Eye opening, and a sad reality .

r58black

Why sad?

r58black

The real question is why is the rate of suicide in physicians so much higher than the general population.
==============
From “Physician Suicide, A Fleeting Moment of Despair”,Psychiatry (Edgmont). 2009 January; 6(1): 18–22. …..

First, compared with the general population, suicide rates among
physicians generally tend to be higher. Second, some studies of the
suicide rates among male physicians have found rates equal to or lower than the general population, though these clearly under-number those that have found higher rates. Third, in all studies to date that have compared physician suicide rates with the general population, female physicians consistently have higher suicide rates than male physicians.
===================

Since physicians are human…or at least probably most of them….they are equally susceptible to suicide as the general population. Furthermore, there is often a lack of distinction as to the reasons for suicide…whether it is out of desperation…or as a final existentialist act of last self determination. Did Hannibal commit suicide or did he simply deny his enemies, the Romans, the opportunity to publicly humiliate him?

Physicians are not immune to desperation. They are unique though compared to other groups in that the profession demands much delayed gratification during the education and training to become a physician. During the period of delayed gratification, one is expected to quietly cloister one’s self away….to often give up one’s youth. French physicians differ from their American associates in this matter in that many opt for delayed entrance into medical school and chose to live a little before entering medical school at the ripe old age of 26 or so.

Any individual, physician or not, is under stress if they are in a setting whereby they are held responsible for a process but they are not in control of that process; in other words, that individual is nothing more than either a human shield for another individual/group of individuals who control the process or is simply a scapegoat eligible for future witch burning if public ire so demands it….even if the process were never under any one’s control.

Physicians are often expected by the general public to be the paragon of honesty and reason in a world that is still mostly driven by the Irrational. American physicians are now increasingly faced with a population that is significantly more litigious compared to other nations (however, this may be misleading in that in many other nations physicians are not as sued as often because most often there is nothing to gain by suing them….i.e. they have no/little money and/or no significant malpractice insurance). Furthermore, American physicians are witnessing a marked blooming of the entitlement society.

If one finds one’s self depressed to the point of suicide due to some predominantly endogenous problem…..then it is best to seek help and management just as would be advised to any one, physician or not.

If one find’s one’s self to be defeated to the point of suicide due to some predominantly exogenous problem….then it is best to analyze, assess and re-evaluate one’s options to respond to that exogenous problem. For instance, if one is a family practice doc having to see up to 80 patients per day….and then do a lot of additional non reimbursable tasks due to associated responsibilities of seeing those 80 patients per day….and is depressed, getting divorced, etc….then one should really self examine and ask “Why the hell am I putting up with this crap? Why do I expect me to sacrifice myself to the point of being a non person? There is a distortion of martyrdom which seems to be more prevalent in western Christian Societies. It is a sick, twisted sense of martyrdom which amazingly drives some very intelligent, honorable people to the point of annihilation and/or ultimately simply selection out of existence while they simultaneously complain about their personal life that they have so voluntarily sacrificed. Too many physicians are prone to succumbing to bad conditions that are simply presented to them in a polite, neat format but whose content entails actual horror of tyranny and lack of self sustainability for the provider.

I have actually had insurance carriers try to shame me into signing a bad contract. It may be great for the carrier….great for the patient….but it definitely is not sustainable and definitely screws the provider. Providers are often poor businessman but are often good fish….i.e. they will take the worm, the hook and the sinker….and then later complain about the metal taste in their mouth while they sink to the bottom. Amazing. Hard sales tactics work well with many providers….shame, guilt, ego stroking, etc. But again…these tactics are not uniquely used against physicians. What is really most surprising is how a group of individuals who are usually more bright than other professional groups can be so stupid. Does the profession groom that kind of attitude? Does the profession attract individuals who are so prone to act in this contradictory manner? Who knows?

The problem exists. The solutions are essentially the same though whether it is for the general population or the physicians.

PamelaWibleMD

“What is really most surprising is how a group of individuals who are usually more bright than other professional groups can be so stupid.”

Exactly what I’ve been pondering.

r58black

Delayed gratification? Excess convoluted thinking? Nerd desk potato? Hyper development of the executive portion of the brain at the disregard of the brain stem portion of self preservation? Milgram effect? Who knows? All I know that when on a team that is on the Titanic…and the team is enthusiastically rearranging the lounge chairs on the Titanic….best to leave them to their folly and doom and get the hell off of the Titanic. I have worked with great teams of docs….and shyte teams of docs. Recall, many years ago, one chief whose concept of team work was having members, usually the new guys/gals, act as a fall guy/gal human shield….to which I quickly replied to him that I didn’t want to be on that f**king team….which seemed to prompt a lot of quiet giggles from all the other team members. Point being…know who you run with. If you have choice then choose.

Dale Howard

When there doesn’t seem to be an answer that can be categorized by psychology then one must research other realms. Dentistry is a profession that has the highest number of suicides. Pretty cut and dry profession without that much malpractice or procedures that would cause lawsuits (listed as number one reason doctors commit suicide). No long surgeries in and out and $750-1,000 for a half hour. $100 for a simple tooth extraction (piece of string and a door knob). There is an answer but such bizarre realities boggle the mind even though the pews are full each and every Sunday.

Dale Howard

Interesting concept, how many female physicians were killed by their significant other and made to look like a suicide, thought provoking?

blancheknott

At the January 2013 quarterly meeting of the Medical Board of California, 2 men from the PACE program at UCSD presented a startling statistic : the suicide rate of female physicians is over three times that of male physicians. When I asked them why, they said they didn’t have a clue. I asked if anyone was studying this. The answer was no & the subject was glossed over as if it hadn’t been mentioned. I find this especially troubling since the MBC president, executive director, virtually all of the high-ranking medical board staff are women. No one seemed to care. [The PACE program is a disciplinary course required of virtually all physicians who are put on probation by the MBC].

PamelaWibleMD

The lack of interest in investigating physician suicide is REALLY sad. Any idea why?

PamelaWibleMD

by the way, I know of no female physicians who have died by suicide. Only men. I’m questioning the accuracy on all of these statistics since nobody seems interested in tracking them.

Kassy Daggett

I’m sure there’s someone out there who actually has some statistics generated. Who is it? A medical examiner? A morgue technician? A newspaper obits editor? An EMT? If you happen to know what’s REALLY been going on in your community please share it!

Kassy Daggett

Beautiful thoughtful and well stated. I’m so glad to know you are in the world making these kinds of observations Michael. What’s next? “There is no way out” is an opportunity to be creative!

Kassy Daggett

Too funny! But only because it’s so true!

Sheri

Love your post, Kassy. Yesterday a friend on Facebook posted that she
had just watched the movie called How To Die In Oregon, then made some
comments about suicide. I replied to her by linking this article. “The
journey of a thousand miles begins with one step.” I appreciate you
appealing to this. I wish you guys could video your Breitenbush conference and send it to medical schools to be used as part of the curriculum. Thank you for the huge work you two are doing for change.

Kassy Daggett

Great idea Sheri. We actually do have some footage from the earlier workshops. All we need is an experienced film production company who believes in the project and wants to take it on. Know anyone?